Assessing Social Determinants of Health in Transplantation and CAR-T Recipients: Expert Panel Recommendations from the Survivorship Special Interest Group of ASTCT

Abstract

Social determinants of health (SDOH) are an increasingly recognized prognostic factor in patients undergoing hematopoietic cell transplantation (HCT) and chimeric antigen receptor-T cell (CAR-T) therapy. However, awareness among providers of their importance and appropriate evaluation of SDOH factors in transplant candidates is insufficient in standard clinical practice and in research. As part of a coordinated effort by 3 American Society for Transplantation and Cellular Therapy (ASTCT) Special Interest Groups, we have developed a general overview of SDOH in transplantation and cellular therapy (TCT) along with suggested best practices. We strongly encourage the assessment of SDOH pre-TCT by a trained member of the team as well as the development of a communication plan tailored to an individual patient's background. Other recommendations include the development and validation of longitudinal instruments for SDOH evaluation in patients undergoing TCT, with emphasis on those that use primary sources of information, the inclusion of SDOH in outcome and mortality benchmarks established by regulatory bodies, and the development of intervention strategies in the context of clinical trials.

Keywords: CAR-T; Deprivation; Health disparities; Hematopoietic stem cell transplantation; Isolation; Poverty; Social determinants of health.