INTRODUCTION
Hematopoietic stem cell transplant (HSCT) is a widely used treatment for many malignant and non-malignant conditions. However, receiving a transplant can cause significant stress for a patient and their family, and life following transplant can present additional challenges. Children often experience high levels of affective and somatic distress at admission for HSCT that escalates after conditioning. This stress is often compounded by strict long-term adherence to medications, frequent monitoring of physical health and labs, and numerous trips to clinic, culminating in an immense psychological toll. As a result, these patients are at a higher risk for acute distress and lingering adjustment problems in later years, affecting their quality of life (QoL).1,2 Poor QoL following HSCT can be related to the psychological outcomes of treatment, impaired social skills due to lack of peer interaction and chronic school absenteeism, cognitive and academic decline, and the stress of loved ones.3,4Studies have generally shown improvements in patient QoL for the years following pediatric HSCT; however, a significant proportion of patients remain at risk for experiencing adjustment difficulties.5,6 QoL after HSCT is increasingly being recognized as a major outcome parameter of readjustment.7,8 Multiple studies have highlighted key factors that affect readjustment and QoL years after pediatric HSCT.9-13 Pre-transplant family cohesion and adaptive abilities of individual patients,10 as well as development of long-term complications of HSCT such as graft versus host disease and other comorbidities,9 are thought to impact readjustment and thus affect QoL.
Race is a known predictor of health-related outcomes, and racial disparities have been shown to be prevalent in a multitude of diseases, including cancers and blood disorders.14-17 Racial disparities in the access to and outcomes of HSCT have been explored, with most studies describing inferior clinical outcomes for Hispanic and Black patients as compared to non-Hispanic Whites;18-22 notably, the impact of racial disparities on the QoL of HSCT patients years after treatment has yet to be explored. With the goal of identifying barriers to improved QoL in transplant patients from marginalized and minority populations, we explored the impact of race and ethnicity on QoL two or more years post-transplant in a cohort of pediatric patients undergoing HSCT. We further explored how transplant and socioeconomic variables might serve as modifiers of such relationships. We hypothesized that (1) race and ethnicity affect the readjustment phase and thus impact QoL, (2) minority pediatric patients will experience lower QoL than their white counterparts, and (3) racial differences in QoL will be modified by the inclusion of socioeconomic variables in our analyses.