{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T14:58:52Z","timestamp":1784213932289,"version":"3.55.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study included adult participants (aged \u226518 years) from 3 cohorts\u2014the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)\u2014who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC\/NMA]); all BMT CTN 1703 participants received RIC\/NMA.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Hematopoietic cell transplant.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity\u2013Functional Assessment of Chronic Illness Therapy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate\u2019s degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (&amp;lt;$40\u202f000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median [range], 0.72 [0.01-0.97] vs 0.61 [0.16-0.78] in the PRO Protocol MAC group), and 16 participants [27.6%] in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC\/NMA group (median [IQR], 28 [14-75] miles vs 47 [16-96] miles for BMT CTN 1703 participants and 49 [21-104] miles for PRO Protocol participants).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.10839","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T15:00:43Z","timestamp":1777993243000},"page":"e2610839","source":"Crossref","is-referenced-by-count":1,"title":["Hematopoietic Cell Transplant Access and Patient Diversity"],"prefix":"10.1001","volume":"9","author":[{"given":"Rachel","family":"Cusatis","sequence":"first","affiliation":[{"name":"CIBMTR, Medical College of Wisconsin, Milwaukee"},{"name":"Blood and Marrow Transplant and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianqun","family":"Kou","sequence":"additional","affiliation":[{"name":"CIBMTR (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitrin","family":"Bupp","sequence":"additional","affiliation":[{"name":"CIBMTR (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Mattila","sequence":"additional","affiliation":[{"name":"CIBMTR (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramzi","family":"Abboud","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Arai","sequence":"additional","affiliation":[{"name":"Stanford Health Care, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Bola\u00f1os Meade","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Carrum","sequence":"additional","affiliation":[{"name":"Center for Gene Therapy, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhagirathbhai","family":"Dholaria","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatema","family":"Fareh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oregon Stem Cell Center, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Hamadani","sequence":"additional","affiliation":[{"name":"CIBMTR, Medical College of Wisconsin, Milwaukee"},{"name":"Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Bone Marrow Transplant Program, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Jamieson","sequence":"additional","affiliation":[{"name":"University of North Carolina Hospitals\u2013Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio M.","family":"Jimenez Jimenez","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Cellular Therapy, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Khimani","sequence":"additional","affiliation":[{"name":"Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. 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