Safe People
Lead applicant organisation name	University of Birmingham

Safe Projects
Project title	Using routinely collected healthcare data to analyse inequities in the care/treatment of ethnic minority blood cancer patients receiving transplants/cellular-therapies.
Lay summary	"How do blood cancer transplant and cellular therapy outcomes differ across different UK populations? Are there differences in presentation of patients at registration for therapy? A focus on ethnic disparities. Blood cancers, cellular therapy and transplants. Blood cancers, including leukemias, myelomas, and lymphomas, are the fifth most common cancers in the UK (as of Aug-2022). They affect different types of blood cells and can be challenging to treat. Stem cell transplants and CAR T-cell therapies play a crucial role in treating relapsing and refractory blood cancers. These treatments provide options for cases that are otherwise difficult to manage. The number of stem cell transplants administered in the UK is rising. Reports show an average 5% increase per year from 2006 to 2019. Challenges in Predicting Treatment Outcomes. Despite the positive impact of these treatments, outcomes for blood cancers remain difficult to predict. Some cases do not respond well to treatment. To improve patient care, we need to understand what differences are present among different patient groups regarding treatment, and from this, understand what influences these differences. Clinical trials often lack representation from different ethnic backgrounds. Addressing Disparities Research should focus on barriers faced by minority populations in blood cancer treatment. Factors like ethnic group, deprivation, and area of residence affect access to, and quality of, care and patient well-being. This research can help us address the unmet needs of different groups and make treatments better for everyone. Population (P): This research focusses on UK patients admitted to UHB (University Hospitals Birmingham). Exposure (E): We’re looking at patients who have undergone or are currently undergoing Car T-cell or haematopoietic stem cell transplantation. Comparator: We’ll compare these patients to overall averages and also make intergroup comparisons. Outcome (O): We’re interested in treatment-related outcomes, and patient presentation at registration to treatment, which we’ll derive from data collected during the patients’ treatment journey. These include information recorded at the start of treatment and during follow-up. Disparities in access and decision-making: (1) We’ll examine how different groups of people access blood cancer therapies. This includes looking at factors recorded at registration like health status, co-existing conditions, and cancer severity. (2) We’ll also analyse time intervals between treatment steps and follow-up reviews. Treatment Efficacy Across Populations – We’ll focus on follow-up data to understand treatment outcomes. Key areas of interest include: (1) Survival statistics – How well patients fare over time. (2) Hazard ratios – Assessing risks of infections (including Covid-19) and non-infectious conditions, secondary malignancies, graft versus host disease. For stem cell transplant we will also look at risk of early/late graft loss, and for Car T-cell therapy, risk of needing subsequent cellular therapy. (3) We’ll also consider differences in donors and genetic matching (haplotypes). With this, differences between patients’ genetic markers will be acknowledged in the analyses. (4) Descriptive statistics will also be used to look at burden of specific complications and changes in patient responses to therapy over time. This project is aimed to be completed in 8 months. By studying these aspects, we aim to highlight key areas to address in blood cancer treatments, to reduce disparities. Providing up-to-date data, highlighting treatment outcomes by different populations, will help to evaluate current practices, and provide evidence to efficacy of future strategies to improve blood cancer outcomes for the population as a whole."
Public benefit statement	"We aim to highlight significant areas of differences across blood cancer patients treated with Car T-cell or haematopoietic stem cell transplant, driving inequalities in care. These areas will not just be descriptive differences, but we aim to highlight where there is evidence to suggest effect of social power structures on these inequalities. This will be undertaken with Baur et al’s framework for intersectional effect decomposition. Throughout the analyses, where possible, we aim to categorise the population against multiple characteristics (having interdependent effects), which will enable us to identify subpopulations who would otherwise be missed with simple univariate analyses. Our analysis aims to categorise clusters of disaggregated groups with similar outcomes, justifying future policies/strategies with effect on a wider population, while maintaining evidence at a finer level. With the lack of evidence in this area of question, this research is vital to suggest ways to improve outcomes across minority groups. The descriptive aspects of our work can be used to evaluate current practices in blood cancer treatment, ensuring outcome disparities are highlighted. Additionally, these can be used to provide evidence to prioritise future strategies, and areas that should receive monitoring."
Latest approval date	04/08/2025

Safe Data
Dataset(s) name	PATHWAY Research Data Hub: PWY022 dataset

Safe Setting
Access type	Data Licence Agreement between the collaborating organisations using secure and controlled data analysis environments.

Safe Outputs
Link	Not yet Published