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Do health care disparities extend to stem cell transplant clinical trials? Unfortunately, yes.

That racial/ethnic disparities exist in health care isn’t news. That racial/ethnic disparities exist in clinical trial representation also isn’t news. But are people from underrepresented racial and ethnic groups also underrepresented in Blood and Marrow Transplant Clinical Network (BMT CTN) clinical trials? One could make assumptions about it, but BMT CTN wanted to know for sure.

A study team led by Mary Horowitz, M.D., principal investigator of the BMT CTN, looked at clinical trial participants from racial/ethnic groups in nine BMT CTN trials enrolling patients between 2014 and 2021. Researchers compared the results to the racial/ethnic group breakdown of the U.S. population from the 2020 census, all potentially eligible hematopoietic stem cell transplant (HCT) recipients in the U.S. overall and at centers participating in each trial. 

The results are in

The results were as one might have predicted. Eight of the nine trials had a lower proportion of participants from underrepresented racial/ethnic groups than the general U.S. population. Three of the nine trials had a lower proportion of participants from underrepresented racial/ethnic groups than potentially eligible HCT recipients in the U.S. And six of the nine trials had a lower proportion of participants from underrepresented racial/ethnic groups than potentially eligible HCT recipients at participating centers. 

The data showed that BMT CTN trials have lower rates of participation by people from underrepresented racial/ethnic groups, which has been observed for other clinical trial networks. Which makes imperative the need for thoughtful interventions to improve the situation. And diligent follow-through. In study design and in provider engagement, funding, eligibility criteria, remote monitoring and endpoints that matter to patients.

A starting point

It has been shown that patients are more likely to participate in a clinical trial when they’re asked to do so by a provider they trust. As a starting point to improve trial inclusion, providers and institutions can make sure to ask all eligible patients to participate in trials. And take the time to engage with patients to make sure they understand the benefits to be gained and any risks involved. 

For BMT CTN, it’s important to have a strong presence in communities and at institutions where people from underrepresented racial/ethnic groups live. Inclusive, diverse clinical trial recruitment takes time and requires robust funding. But it’s worth it to ensure that trial results are reflective of the overall population. Only when everyone has equal access to potentially lifesaving care do we succeed. We can do better. We must do better. 

Learn more by reviewing a comprehensive analysis and description of the study.

View Infographic

CO-AUTHORS

Mary Horowitz
Manmeet Kaur
Adam Mendizabal
Min Chen 
Anita D’Souza 
Amy Foley 
Jeffery Auletta 
Steven M. Devine