Abstract / Summary
Background: Hematopoietic stem cell transplantation (HSCT) is curative for several pediatric malignant and non-malignant disorders. Despite advances in transplant care, access remains limited in low- and middle-income countries, particularly within public healthcare systems. Data on barriers to pediatric HSCT in government-funded centers in India are scarce. Aims and Objectives: The aims of this study were to evaluate access to pediatric HSCT by determining the proportion of children who underwent transplantation and identifying barriers to proceeding with HSCT. Materials and Methods: This retrospective observational study included children ≤18 years evaluated for HSCT at the Bone Marrow Transplant Unit, Kidwai Memorial Institute of Oncology, Bengaluru, between April 2022 and December 2023. Demographic characteristics, socioeconomic status (modified Kuppuswamy scale, 2023), diagnosis, HSCT indication, transplant status, and reasons for nontransplantation were retrieved from institutional records. Results: Among 220 children evaluated for HSCT, 186 (85%) belonged to lower-middle or upper-lower socioeconomic strata, and 70% had caregivers engaged in daily-wage labor. Malignant disorders accounted for 164 (74.5%) indications, with acute lymphoblastic leukemia being the commonest diagnosis (42.9%). Only 26 children (12%) underwent HSCT. Financial constraints were the leading barrier, accounting for 64% of non-transplanted cases, followed by disease progression and treatment refusal. No transplant-related mortality occurred during the study period. Conclusion: Only a small proportion of children evaluated for HSCT underwent transplantation. Financial constraints were the predominant barrier, highlighting the need for improved financial protection and timely access to transplant services to promote equitable pediatric HSCT in resource-limited settings.