{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:54:43Z","timestamp":1781679283749,"version":"3.54.5"},"reference-count":54,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Multiple Myeloma (MM) remains the most common indication for Autologous Stem Cell Transplant (ASCT). ASCT use is disproportionately lower in older adults, Black patients with MM, as well as those living in rural areas and of low socioeconomic status (SES). Low utilization of ASCT is linked to poor outcomes. There are numerous barriers to ASCT access and limited interventions to address disparate outcomes in patients with MM. Methods: This is an ambispective study conducted at a single institution to identify and mitigate barriers to ASCT utilization. In aim one, we retrospectively evaluated ASCT utilization and overall survival (OS) for MM patients accounting for clinical, geographic (Rural Urban Commuting Area\u2014RUCA), and socioeconomic factors (Yost). In aim two, based on the observations of the retrospective study, we conducted a prospective feasibility study to improve access for vulnerable patients with MM (older adults, Black patients, rural and\/or Appalachian residence) using a virtual ASCT consultative model with patient navigation, coordinated with local oncology centers. Poisson regression estimated the relative risk of receiving ASCT. OS was calculated from MM diagnosis to the date of death censoring survivors at last contact and analyzed using Kaplan-Meir. Cox proportional hazard models estimated the hazard ratio for risk of death. The multivariable model was built including significant risk factors from the univariable models to estimate the independent effect of each risk factor. Results: Among 1799 patients, median age of diagnosis was 61 (range 17\u201387), race was self-identified as White (85.6%), Black (13.1%), or other (1.3%) and it was primarily metropolitan (n = 1205, 71.2%) and 1169 (65%) received a transplant. The hazard of death was lower for those who received a transplant (vs. no transplant, HR = 0.63, 95%CI 0.53\u20130.74, p &lt; 0.001), patients identified as Black (vs. White, HR = 0.66, 95%CI 0.51\u20130.85, p = 0.001) and higher SES areas (quartile 2\u20134 vs. quartile 1, HR = 0.69, 95%CI 0.58\u20130.83, p &lt; 0.001). Prospectively with patient navigation and virtual consultation (n = 35), half of the patients sought virtual consultation, 68% of patients were eligible for transplant, 43% went on to receive ASCT, of which 42% of patients were non-metropolitan and 15% of patients were from an Appalachian county. Using this strategy, no difference was observed in ASCT utilization by age (31% in age &gt; 70 vs. 45% in age 65\u201370 vs. 78% in age &lt; 65, p = 0.10), geographical area (47% in metro vs. 50% in non-metro, p = 0.99), or race (46% in White vs. 60% in Black, p = 0.66). Conclusions: Implementing patient navigation and virtual transplant consultation can effectively enhance access to ASCT among underserved MM populations while reducing the influence of racial and geographic differences.<\/jats:p>","DOI":"10.3390\/cancers18121967","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:56:31Z","timestamp":1781675791000},"page":"1967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moving Mountains: Improving Access to Autologous Stem Cell Transplant for Vulnerable Patient Populations"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8838-1025","authenticated-orcid":false,"given":"Srinivas","family":"Devarakonda","sequence":"first","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuhong","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Keirns","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naresh","family":"Bumma","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-2583","authenticated-orcid":false,"given":"Abdullah M.","family":"Khan","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8676-7840","authenticated-orcid":false,"given":"Francesca","family":"Cottini","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Umyarova","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8327-9586","authenticated-orcid":false,"given":"Nowshin","family":"Islam","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse J.","family":"Plascak","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Electra D.","family":"Paskett","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2484-5887","authenticated-orcid":false,"given":"Jessica","family":"Krok-Schoen","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1302-7099","authenticated-orcid":false,"given":"Nidhi","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Benson","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley E.","family":"Rosko","sequence":"additional","affiliation":[{"name":"Division of Hematology, James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","first-page":"3","article-title":"Multiple myeloma: A clinical overview","volume":"25","author":"Anderson","year":"2011","journal-title":"Oncology"},{"key":"ref_2","unstructured":"American Cancer Society (2026, April 14). 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