Trends and Predictors of Hematopoietic Cell Transplant Utilization for Human Immunodeficiency Virus-Lymphoma in California, 1991 to 2016
Year: 2026
Type: article
Study design: Observational Study
Abstract: Hematopoietic cell transplant (HCT) is a potentially curative treatment for relapsed or refractory lymphoma, and population-level patterns of HCT utilization among people with human immunodeficiency virus (HIV) are poorly characterized. The purpose of this study is to quantify HCT utilization in people with HIV-lymphoma and examine the associations between sociodemographic factors and clinical characteristics of HCT utilization among people with HIV-lymphoma. We used a linkage between the Center for International Blood and Marrow Transplant Research registry, California Cancer Registry, and the California Patient Discharge Database and included adults (18 to 79) diagnosed with first-primary lymphoma from 1991 to 2016 following an HIV diagnosis. Cumulative incidence of HCT use for lymphoma, accounting for the competing risk of death, was estimated overall and by combination antiretroviral therapy (ART) eras. Adjusted Cox proportional hazards models evaluated sociodemographic and clinical factors associated with HCT use. Among 6248 patients with HIV-lymphoma, the cumulative incidence of HCT use at 60 mo was 4.8%. The cumulative incidence increased from 1.9% (95% confidence interval [CI]: 1.0 to 3.5) in the precombination ART era (1991 to 1996), to 4.7% (CI: 3.5 to 6.1) in 1997 to 2005, and 7.2% (CI: 5.6 to 9.0) in 2006 to 2016 (P < .0001). Factors associated with lower HCT use included older age (hazard ratio [HR] = 0.98, CI: 0.96 to 0.99), low socioeconomic status (HR = 0.38, CI: 0.25 to 0.59), single/unmarried (HR = 0.5, CI: 0.34 to 0.73), and public insurance (HR = 0.64, CI: 0.44 to 0.93). In this large, diverse population of people with HIV, HCT utilization increased after combination ART introduction, but remains low, with significant sociodemographic and clinical disparities that may limit access to current and future HCT therapies.
Institutions: University of California, Davis, University of California Davis Medical Center, UC Davis Comprehensive Cancer Center, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, University of California, San Francisco, National Marrow Donor Program, Nationwide Children's Hospital, Stanford University
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W7214039985