ABCL-161 Reasons for Non-Referral for Autologous Stem Cell Transplantation in Central Nervous System Lymphoma (CNSL) Patients in a Minority-Rich, Multiracial, and Underprivileged Population at Montefiore Medical Center, Albert Einstein College of Medicine

Context: We determined the reasons limiting access to autologous stem cell transplantation (ASCT) in CNS lymphoma patients. Disparities in access to ASCT have been reported but studies analyzing the reasons are sparse. We found only one such study done by Hyun D et al at Grady Memorial hospital where established clinical criteria and poor functional status were the leading causes of non-referral for ASCT. Objectives: To analyze reasons limiting access to ASCT in CNSL. Design: Retrospective cohort including patients from 06/15/1999-04/05/2022. Setting: Tertiary oncologic center. Patients: 71 CNSL patients, median age at diagnosis 63 years, Asians 5.7%, Blacks 32.8%, Hispanic 37%, White 12.8%, American Indians 0.1% and Others 10%. 17.1% of the patients were HIV positive. Methods: Electronic chart review. Results: 32.8% (23/70) of CNSL patients received ASCT. HIV-positive status was associated with poor ECOG performance status at diagnosis (p=0.03). 47/70 patients were not offered ASCT because 14 (29.7%) had poor baseline functional status at diagnosis, functional status of 5 (10.6%) patients deteriorated after induction therapy, 6 (12.7%) refused ASCT, 3 (6.3%) were non-compliant with treatment, and for 2 (4.2%) patients provider chose different consolidation treatment, 1 died before ASCT could be done and 4 (8.5%) lost to follow-up and unknown reason for 12 (25.5%) patients. HIV-positive status was significantly associated with decreased access to ASCT in the logistic regression model (p=0.01). Majority of HIV-positive patients did not receive ASCT due to poor performance status (41.7%). 62.5% of HIV-positive patients with uncontrolled disease didn't receive ASCT due to poor performance status. Those with controlled HIV refused ASCT (50%) or were not offered ASCT (50%) due to non-compliance. Access to ASCT was not affected by socioeconomic status or race/ethnicity. Conclusions: In our population, ASCT was not offered to patients for medical reasons like poor functional status rather than socioeconomic reasons. However socioeconomic factors could be responsible for poor functional status. HIV status was also a significant factor for limited access to ASCT. Further evaluations are needed to identify modifiable factors that can improve referral and assess the impact of ASCT in CNSL.