Access to Transplant Care and Social Determinants of Health.

Stem cell transplant is a potentially curative treatment for many hematologic conditions and is often one of the only curative options for many otherwise fatal hematologic malignancies. However, the ability to offer allogeneic transplant for patients who need this treatment is often limited by availability of an HLA-matched donor. Recently, developments in graft-vs-host disease prevention and the advent of PTCy have expanded the donor pool to include HLA-mismatched and HLA-haploidentical donors, but challenges in optimizing GVHD risk and post-transplant complications remain in these settings and can limit access to patients who have comorbidities or are of older age.Outside of medically optimizing patients for transplant, the success of transplant is largely determined by a patient's social support and access to dedicated caregivers for extended periods of time. Ability to recover post-transplant is also determined by their ability to fund adjunctive therapies including nutritional support, physical therapy and rehabilitation, and the resources required to obtain necessary medications and medical attention in a timely manner. Thus, social determinants of health such as food insecurity, transportation insecurity, housing insecurity, and social support become large determinants of transplant success as well.