急性髓系白血病 (AML) 通常需要同种异体造血细胞移植 (alloHCT) 来治愈，但历史上 alloHCT 的利用明显不足。其原因在人口层面仍不确定。我们使用合并国际血液和骨髓中心的链接数据集检查了 alloHCT 随着时间的推移的利用情况，并按年龄组（AYA 15-39 岁、成人 40-64 岁、老年人 65-79 岁）探讨了人口/医疗保健因素与 alloHCT 使用之间的关联。移植研究、加州癌症登记处和加州患者出院数据库。资格包括 2001 年至 2016 年间在加利福尼亚州新诊断出患有 AML、接受诱导治疗且既往未接受过 HCT 的患者。多变量精细灰色回归分析分别针对不同年龄组进行拟合。在 7,925 名 AML 患者中，所有年龄组的 alloHCT 利用率随着时间的推移而增加；然而，在最近的研究时期（2011-2016），相对于成人（41%）和 AYA（49%），老年人（13%）在诊断后 2 年内的使用率仍然最低。与较低的 alloHCT 使用率显着相关的因素在统计学上显着相关：(1) AYA：女性、较低的社区社会经济地位 (nSES)、无保险或印度医疗服务 (IHS) 覆盖率； (2) 成年人：年龄较大、男性、非西班牙裔黑人或亚洲人种和民族、未婚、nSES 较低、没有医疗补助、医疗保险或 IHS 保险或承保、合并症较高、居住在距离移植中心 100 英里的地方； (3) 老年人：年龄较大、亚洲人种、未婚。总之，使用基于人群的关联数据集，我们证明在加利福尼亚州新诊断为 AML 的老年患者中 alloHCT 的利用率仍然较低，并且与利用率相关的因素因年龄组而异。

Acute myeloid leukemia (AML) often requires allogeneic hematopoietic cell transplantation (alloHCT) for cure, but historically alloHCT has been strikingly underutilized. Reasons for this remain uncertain at the population level. We examined alloHCT utilization over time and explored associations between demographic/healthcare factors and use of alloHCT by age group (AYA 15-39y, adult 40-64y, older adult 65-79y) using a linked dataset merging the Center for International Blood and Marrow Transplant Research, California Cancer Registry, and California Patient Discharge Database. Eligibility included patients newly diagnosed with AML in California between 2001-2016 who received induction therapy and had no prior HCT. Multivariable Fine-Gray regression analyses were fitted separately across age groups. Among 7,925 patients with AML, alloHCT utilization increased over time across all age groups; however, in the most recent time period studied (2011-2016), utilization within 2 years of diagnosis remained lowest in older adults (13%) relative to adults (41%) and AYAs (49%). Factors statistically significantly associated with lower alloHCT utilization: (1) AYAs: female sex, lower neighborhood socioeconomic status (nSES), uninsured or Indian Health Services (IHS) coverage; (2) adults: older age, male sex, non-Hispanic Black or Asian race and ethnicity, unmarried, lower nSES, uninsured or covered by Medicaid, Medicare, or IHS, higher comorbidity, and living 100+ miles from a transplant center; and (3) older adults: older age, Asian race, and unmarried. In conclusion, using a population-based linked dataset, we demonstrate that utilization of alloHCT among older patients newly diagnosed with AML remains low in California, and factors associated with utilization vary by age group.