Abstract | PURPOSE: From a global perspective, the rates of allogeneic hematopoietic cell transplantation (alloHCT) are closely related to the economic status of a country. However, a potential association with outcome has not yet been documented. The goal of this study was to evaluate effects of health care expenditure ( HCE), Human Development Index (HDI), team density, and center experience on nonrelapse mortality (NRM) after HLA-matched sibling alloHCT for adults with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: A total of 983 patients treated with myeloablative alloHCT between 2004 and 2008 in 24 European countries were included. RESULTS: In a univariate analysis, the probability of day 100 NRM was increased for countries with lower current HCE (8% vs. 3%; p = .06), countries with lower HDI (8% vs. 3%; p = .02), and centers with less experience (8% vs. 5%; p = .04). In addition, the overall NRM was increased for countries with lower current HCE (21% vs. 17%; p = .09) and HDI (21% vs. 16%; p = .03) and for centers with lower activity (21% vs. 16%; p = .07). In a multivariate analysis, the strongest predictive model for day 100 NRM included current HCE greater than the median (hazard ratio [HR], 0.39; p = .002). The overall NRM was mostly predicted by HDI greater than the median (HR, 0.65; p = .01). Both lower current HCE and HDI were associated with decreased probability of overall survival. CONCLUSION: Both macroeconomic factors and the socioeconomic status of a country strongly influence NRM after alloHCT for adults with ALL. Our findings should be considered when clinical studies in the field of alloHCT are interpreted.
|
Authors | Sebastian Giebel, Myriam Labopin, Adalberto Ibatici, Paul Browne, Tomasz Czerw, Gerard Socie, Ali Unal, Slawomira Kyrcz-Krzemien, Andrea Bacigalupo, Hakan Goker, Mike Potter, Caroline L Furness, Grant McQuaker, Dietrich Beelen, Noel Milpied, Antonio Campos, Charles Craddock, Arnon Nagler, Mohamad Mohty |
Journal | The oncologist
(Oncologist)
Vol. 21
Issue 3
Pg. 377-83
(Mar 2016)
ISSN: 1549-490X [Electronic] England |
PMID | 26869584
(Publication Type: Journal Article, Multicenter Study)
|
Copyright | ©AlphaMed Press. |
Topics |
- Adolescent
- Adult
- Female
- Graft vs Host Disease
- Health Care Costs
- Hematopoietic Stem Cell Transplantation
(adverse effects, economics, mortality)
- Humans
- Male
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma
(economics, mortality, therapy)
- Retrospective Studies
- Socioeconomic Factors
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
|