Telehealth May Offer a Path to More Equitable Myeloma Transplant Access

For patients with multiple myeloma, access to a transplant specialist can be shaped by more than clinical eligibility. Age, race, socioeconomic status, and where a patient lives can all influence whether they ultimately receive an autologous stem cell transplant. A recent study from The Ohio State University Comprehensive Cancer Center examined these disparities and explored whether bringing the transplant consultation closer to patients through telehealth could help reduce some of the barriers associated with traveling to a tertiary care center.¹

In an interview with Targeted Oncology^TM, Ashley Rosko, MD, hematologist at The Ohio State University Comprehensive Cancer Center, discussed how virtual consultations helped patients navigate transplant evaluation and how similar approaches could be applied to cellular therapy and other specialized treatments.

Targeted Oncology: What was the rationale for your study?

Ashley Rosko, MD: Most patients [with cancer] are diagnosed and treated in their community, and that's where patients want to be…to be able to live within the community and be able to get the therapy that they need. We want that for [patients] too. But we also recognize that there are cancers like multiple myeloma that are rare and certainly benefit from having an evaluation at a tertiary care center, given the rarity of the disease and the changing landscape and the need for more specialized care—in this case, autologous stem cell transplant.

Autologous stem cell transplant is a standard of care for patients newly diagnosed with multiple myeloma, and we know that certain populations are much less likely to receive an autologous stem cell transplant. The reasons for that are multifactorial, but that's what we sought to explore within this manuscript, so it was kind of twofold. One [goal] was to be able to look at our data to be able to recognize patients that are less likely to receive an autologous stem cell transplant; the second part was to [determine] what interventions or things can we do to create access so patients can have better outcomes.

What were your initial findings about who were less likely to receive a transplant?

For the first part of the study when we were looking at who was least likely to receive an autologous stem cell transplant, we and others have [previously] shown that patients who are older, Black or African American, or from rural environments—especially here in Ohio, Appalachian [areas]—are the least likely to receive an autologous stem cell transplant. In this patient population, a large group of nearly 2000 patients, we identified some of those same risk factors, in which we found that patients that were older, identified as Black, and from a lower socioeconomic status area were the least likely to receive a stem cell transplant.

How could telehealth visits help address some of the racial, socioeconomic, and geographic disparities you observed in access to transplant?

What we then thought was, can we reduce the barriers? Just like Ohio, many areas in the United States are rural, and being able to communicate in a virtual way removes some of the barriers to seeing a tertiary care specialist. We reached out to some of the community sites, in particular some Appalachian sites, and let them know that if patients need to be seen, that we would offer a virtual consultation with a bone marrow transplant doctor, so that way patients can stay in their home environment. We can get all of their records; they never had to come here, and then we can see them for consideration of an autologous stem cell transplant. When we offered that for the patient population, the main take-home was that we were able to mitigate some of those influences of racial and geographic differences, meaning that we didn't necessarily see the differences in geography in terms of transplant access, and we didn't see the differences in age or race when using the [telehealth] strategy. [In other words, we were] able to level the playing field for patients if [telehealth] access was the same.

Importantly, when we did see patients in that fashion, we saved some of them a trip, because when we saw some of those patients for transplant evaluation, some of them were not patients that needed a transplant or were eligible for a transplant, for lots of different factors. It was a small cohort of 35 patients; over a virtual visit, 6 of them [were told they] don't need a transplant or are not eligible for a transplant. Some of them didn't have myeloma at all, had precursor conditions, and so that was a quick evaluation to say, this is definitely not in the cards for you. [For] those patients who were thought to be transplant eligible, we were able to see them for a second visit and get them access to a transplant. It was a variety of different patients that sought to have the virtual navigation in our experience. Some of [the cases were], “Let's hear about it first to see if we want to make the travel.” Some of the patients were doing shift work and work nights, and so it was nice [for them] to be able to have a virtual visit in the morning without having to go someplace. Some of those patients didn't have transportation or a caregiver but just wanted to hear the information to see if they wanted to come for the potential evaluation. I think the ability to work with patients in their own communities, especially for something as rare or uncommon as myeloma, and connect them with an expert from their own home, is going to be helpful not only for newly diagnosed patients but also for those who may need CAR T [chimeric antigen receptor T-cell therapy] or other advances in myeloma care.

What are potential implementation barriers to anticipate with telehealth programs?

One is insurance. Sometimes we can't see patients across state lines; there are some Medicare barriers to being able to do telehealth in those ways… We need to have good connections with our community partners that they know that this option exists, because some patients are pretty reticent about going to a big cancer center, going to a place with things that we don't even think about—parking and shuttles and things that are just a little bit harder to navigate in a bigger city—vs your local community place. But also importantly, we want patients to stay in their community to be able to get treatment. We just need to make sure that if they have something rare or uncommon, they're seeing somebody who sees that every day.

What are the next steps after this study?

This [study] was our test run, but I think one of the things that we are thinking about is how we can make these [programs] more accessible for CAR T and cellular therapy, and how we can do the same type of model for patients who need consultation. We do a lot of telehealth for patients who have a low-risk, [monoclonal gammopathy of undetermined significance (MGUS)] type of screening that just need a once-over for virtual consultations. I think that CAR T and cellular therapy is probably a place to do this, and I would be very curious about ways that we could collaborate on some type of interface so patients can learn about clinical trials too.

REFERENCE

1. Devarakonda S, Zhao Q, Keirns S, et al. Moving Mountains: Improving Access to Autologous Stem Cell Transplant for Vulnerable Patient Populations. Cancers. 2026;18(12):1967. doi:10.3390/cancers18121967