29 March 2021

Patients with mantle cell lymphoma (MCL) are less likely to be offered a stem-cell transplant if they are unmarried or have a lower level of education, according to a Swedish analysis.

Treatment for the condition can include autologous haematopoietic stem cell transplantation after induction chemotherapy. Comorbidities have previously been linked to a lower chance of being offered transplant. In a new study, Dr Ingrid Glimelius of Uppsala University, Sweden, and colleagues looked at other factors governing the decision whether to offer autologous stem cell transplant.

The team analysed outcomes for 369 adult MCL patients diagnosed from 2000 to 2014, on the Swedish Lymphoma Register.

60% of patients were treated with a stem cell transplant within 18 months. Investigating factors associated with this decision, the team found that, compared with married patients, never-married and divorced patients had a lower likelihood of transplant. Patients with a less than 10 years of schooling were also less likely to receive a transplant, compared to patients with between 10 and 12 years of education.

Details were published recently in the journal Blood Advances. The authors report that stem cell transplant was linked to a 42% reduced all-cause mortality, and that transplant-related mortality was low, at 2%.

“An undue concern about performing an autologous haematopoietic stem cell transplantation in certain societal groups was seen,” they state.

Dr Glimelius said: “We don't know exactly why the unmarried or less educated patients got transplants less often, but we can speculate that less social support, or inadequate information, may lead to a fear – in both the patient and doctor alike – of undergoing a very demanding treatment."

She added: “This study shows that the people who weren’t selected for a transplant had clearly lower survival. This suggests that transplantation is a very important component in the treatment.”

She concludes: “Studies of this kind are important because they can lead to certain groups in society being offered more support. They can also act as an eye-opener for patients, health professionals and politicians alike, showing that there’s still a need for more equality in health care."


Glimelius I, Smedby KE, Albertsson-Lindblad A, Crowther MJ, Eloranta S, Jerkeman M, Weibull CE. (2021) “Mantle cell lymphoma patients unmarried or with low education are less often transplanted leading to lower survival.” Blood Advances, doi: 10.1182/bloodadvances.2020003645


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