Clinical Report: Impact of Social Vulnerability Index on Survival After MM Autologous SCT
Overview
This study evaluated the influence of the Social Vulnerability Index (SVI) on survival outcomes in multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT). Findings suggest that patients residing in areas with higher SVI scores experience different survival outcomes compared to those in lower SVI areas, highlighting the role of social determinants in post-transplant prognosis.
Background
Multiple myeloma prognosis has improved with novel therapies and ASCT remains the standard of care for eligible patients, prolonging progression-free survival. While clinical factors influencing survival after ASCT are well studied, the impact of social determinants such as local social vulnerability is less understood. The CDC Social Vulnerability Index (SVI), a composite measure of 16 social factors grouped into four themes, has been used to identify populations at risk during public health emergencies and recently explored in cancer outcomes. This study investigates the association between SVI and survival in MM patients undergoing ASCT.
Data Highlights
A retrospective single-center study included MM patients undergoing ASCT from 2012 to 2020 in Virginia. Patient data included demographics, disease risk, treatment, and outcomes, linked to county-level SVI scores. SVI scores ranged from 0.00 to 1.00, with higher scores indicating greater social vulnerability. Patients were categorized into low and high SVI groups based on their county of residence. Outcomes such as progression-free survival and overall survival were analyzed in relation to SVI.
Key Findings
Patients residing in counties with higher SVI scores demonstrated differences in survival outcomes after ASCT compared to those in lower SVI counties.
Higher social vulnerability was associated with factors such as socioeconomic status, household characteristics, minority status, and housing/transportation challenges.
Social vulnerability impacted access to care and possibly post-transplant maintenance therapy adherence, influencing progression-free survival.
Race and insurance status were collected but the study primarily focused on the composite SVI impact rather than individual demographic factors.
This is the first study to evaluate the role of local-level social vulnerability on outcomes after MM ASCT, expanding understanding beyond traditional clinical risk factors.
Clinical Implications
Clinicians should consider social vulnerability as a factor influencing post-ASCT outcomes in MM patients. Integrating SVI assessment may help identify patients at higher risk of adverse outcomes due to social determinants, guiding supportive interventions and resource allocation. Addressing social vulnerabilities could improve access to maintenance therapies and follow-up care, potentially enhancing survival.
Conclusion
The Social Vulnerability Index is a significant factor associated with survival outcomes following autologous stem cell transplantation in multiple myeloma patients. Incorporating social determinants into clinical risk stratification may optimize patient management and improve long-term outcomes.
