Expanding Access to Autologous Transplant: Early Outcomes from a Public Safety-Net Hospital Serving Underrepresented Populations

Introduction Access to autologous (auto) transplant is often limited for under-resourced patients (pts), perpetuating racial, ethnic, and socioeconomic disparities in outcomes. Few reports describe outcomes of cellular therapy in public safety-net hospitals. In January 2023, MetroHealth, a large, urban public safety-net hospital in Cleveland, Ohio, launched an auto transplant program to expand access for underrepresented patients. Methods We conducted a single-center retrospective review of consecutive pts who underwent auto transplant from January 2023 to July 2025. Demographic, clinical, and outcome data were extracted from medical records. Descriptive statistics were used to summarize the data. Results Twenty-three pts received auto transplants over 31 months; median age 60 years (range 20-75), 61% male. The cohort was racially and ethnically diverse: 35% were Black and 13% Hispanic, compared to 17% and 13%, respectively, in CIBMTR registry data (Table 1). Median Karnofsky score was 80% (range 60-100%). Insurance coverage reflected socioeconomic vulnerability: 52% Medicaid, 26% Medicare, and 22% marketplace/private insurance. Average income by zip code was $61,870 (median $65,778), which was below the county ($68,360; 2023) per capita income. Myeloma was the primary indication (70%) for transplant. Disease status at transplant was 43% complete remission, 17% very good partial remission, and 39% partial remission. All pts successfully received their transplant, with one early transplant-related mortality (<100 days(d)). Engraftment occurred as expected (median ANC 11.5d, median platelet 19d). Four pts required ICU transfer (median stay 3.5d). One patient was readmitted within 48 hours (fever) and 2 others within 30d. Conclusion Establishing an auto transplant program in a public safety net hospital is feasible, safe, and expands access to populations historically excluded from treatment. Our pt cohort was racially diverse and socioeconomically vulnerable. Despite small numbers and short follow-up, our experience demonstrates the ability to reduce racial/ethnic and socioeconomic disparities in access to auto transplant. These findings underscore the role of safety-net hospitals in reducing disparities and highlight the need for further expansion of such programs as a strategy to address inequities in access.