Donor Socioeconomic Status As a Predictor of Altered Immune Function and Treatment Response Following Hematopoietic Cell Transplantation for Hematologic Malignancy

Introduction: Hematopoietic cell transplantation (HCT) carries significant risks for mortality, which are not proportionally shared across individuals. Among HCT recipients, we have previously shown that low socioeconomic status (SES) is predictive of increased mortality following HCT, and the underlying mechanism for this outcome is not fully explained by race, insurance status or access to care. Furthermore, following HCT, the donor immune system replaces that of the recipient, leading to long-term engraftment with donor-derived immune cells. Previous work has not addressed the influence of donor socioeconomic factors on HCT recipient outcomes. Therefore, we hypothesized that SES would impact donor hematopoietic cells and this effect would be transferrable and associated with adverse recipient outcomes.