Staying Aware of Psychosocial and Systemic Barriers to Allogeneic SCT

Samantha E. Watters, PhD, MPH, principal provider education and research partner at the National Marrow Donor Program (NMDP), highlights that while medical and scientific advances have transformed hematopoietic cell transplantation, significant barriers continue to limit patient access. Historically, locating an appropriately matched donor presented the primary obstacle to treatment. Today, advancements in donor registry matching and support for mismatched transplantation ensure that a suitable donor can be identified for virtually any patient requiring a transplant. However, non-matching factors, specifically economic, social, and structural hurdles, now represent the most formidable barriers to care.

Allogeneic transplantation is an exceptionally resource-intensive and time-consuming procedure. Protocol guidelines frequently require patients to relocate near the treatment facility for up to 100 days posttransplant. This demand creates profound challenges for individuals facing financial instability, limited health literacy, language barriers, or inadequate health insurance. Furthermore, the absence of a reliable full-time caregiver or dependable transportation can immediately compromise a patient's eligibility. Geographic disparities compound these psychosocial challenges, as many regions lack local hematology-oncology specialists and specialized transplant centers, forcing patients to navigate severe physical access limitations.

In addition to psychosocial and structural constraints, historical misconceptions regarding age continue to restrict referrals. Historically, advanced age served as a strict exclusion criterion for transplantation. With the advent of reduced-intensity conditioning regimens, age alone no longer disqualifies patients, provided their comorbid conditions are manageable. However, this scientific shift has not fully saturated community practice. Many diagnosing and community providers still operate under outdated age cutoffs, prematurely assuming older patients are ineligible.

To expand equitable access, the NMDP emphasizes the need for ongoing education directed at community clinicians. Ensuring primary and diagnosing providers understand that age is no longer a definitive barrier allows care teams to focus on identifying and proactively mitigating the complex psychosocial and logistical obstacles that truly dictate transplant success.