Страховка по Medicaid снижает шансы на трансплантацию стволовых клеток у пациентов с множественной миеломой

For individuals with newly diagnosed multiple myeloma (MM), being covered by Medicaid is associated with a reduced likelihood of undergoing autologous stem cell transplantation (ASCT), according to research published in Cancer. In addition, Medicaid coverage was more common among Black individuals than White individuals in this study, researchers reported. “Differences in survival after MM are shaped in part by access to care, including insurance coverage and access to effective therapies like ASCT,” the researchers noted. This study was based on records from the Flatiron Health Research Database for individuals with newly diagnosed MM. Real-world overall survival (rwOS), likelihood of receiving ASCT, and insurance coverage patterns were evaluated for non-Hispanic Black and non-Hispanic White patients. Of 4932 patients with MM, 24% were Black. Median age at diagnosis was 67.1 years in Black individuals and 71.5 years in White individuals. Sixteen percent and 4.8% of individuals, respectively, were covered by Medicaid. In an rwOS analysis adjusted for several demographic and clinical factors, mortality was significantly higher for Black patients than for White patients (adjusted hazard ratio [aHR], 1.11; 95% CI, 1.00-1.23). However, a difference by race was not statistically significant after adjustment for ASCT (aHR, 1.07; 95% CI, 0.96-1.19). Among patients diagnosed at an age younger than 65 years, worse rwOS was observed with Medicaid coverage than with private insurance (aHR, 1.61; 95% CI, 1.16-2.24). Medicaid coverage among individuals younger than 65 years was also associated with a significantly lower rate of ASCT (adjusted subdistribution HR [asHR], 0.50; 95% CI, 0.38-0.67). Compared with not receiving ASCT, undergoing ASCT was associated with reduced overall mortality (aHR, 0.59; 95% CI, 0.51-0.67). Black patients were less likely than White patients to undergo ASCT, both among those younger than 65 years (asHR, 0.63; 95% CI, 0.54-0.74) and those at least 65 years of age (asHR, 0.54; 95% CI, 0.42-0.69). Black patients were also less likely to undergo ASCT after the researchers adjusted for insurance. Among patients who underwent ASCT, the time to transplantation varied by race. The median time from diagnosis to transplantation among patients younger than 65 years was 8.1 months for Black individuals and 7.2 months for White individuals (aHR, 0.82; 95% CI, 0.71-0.95; P <.001). For those at least 65 years of age, median times to transplant were 7.9 months and 7.1 months, respectively (aHR, 0.84; 95% CI, 0.67-1.06; P =.059). Medicaid coverage at diagnosis was more likely for Black patients than White patients in both Medicaid expansion states and nonexpansion states. Medicaid expansion at diagnosis was not associated with improvements in rwOS or receipt of ASCT but was associated with lower odds of Medicare coverage (adjusted odds ratio, 0.64; 95% CI, 0.44-0.93). “Together, these findings suggest that Medicaid coverage is an important barrier to ASCT and that Medicaid expansion alone may be insufficient to improve access to complex therapies or eliminate disparities in outcomes,” the researchers concluded. “Addressing these inequities will likely require coordinated strategies beyond coverage expansion, including more consistent transplantation policies, supportive services, equitable referral practices, and patient‐centered navigation to ensure that advances in MM therapy benefit all populations,” they added. Disclosures: This research was supported by Blood Cancer United. Some study authors disclosed conflicts of interest. Please see the original reference for complete disclosures. References: Wong FL, Goldsmith SR, Ashing K, Krishnan A, Rosenzweig MA, Armenian SH. Racial differences in multiple myeloma survival: Associations with stem cell transplantation, insurance, and Medicaid expansion. Cancer. Published online September 1, 2026. doi:10.1002/cncr.70596