There is a strong correlation between a nation’s economic status and the rates of allogeneic hematopoietic cell transplantation (alloHCT). Yet, there is no documentation about a prospective relationship with the outcome. Assessing the effects of healthcare expenditure (HCE), Human Development Index (HDI), center experience, and team density on non-relapse mortality (NRM) after human leukocyte antigens (HLA)-matched sibling alloHCT for grown-up patients with acute lymphoblastic leukemia (ALL) was the purpose of this investigation. For a study, 983 patients from 24 European nations were considered. From 2004 to 2008, these patients were treated with myeloablative alloHCT.
Nations with lower HCE (8% vs. 3%; p=0.06), nations with lower HDI (8% vs. 3%; p=0.02), and centers with experience (8% vs. 5%; p=0.04) demonstrated an increase in probability of day 100 NRM in a univariate analysis. Additionally, nations 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) also demonstrated an increase in overall NRM. Plus, the current HCE greater than the median (hazard ratio [HR], 0.39; p=0.002) was the strongest predictive model for day 100 NRM in a multivariate analysis. HDI greater than the median (HR=0.65; p=0.01) was mostly used to predict overall NRM. As such, the reduced probability of overall survival was related to both lower current HCE and HDI.
Non-relapse mortality (NRM) after human leukocyte antigens (HLA)-matched sibling alloHCT for grown-up patients with acute lymphoblastic leukemia (ALL) is heavily influenced by both socioeconomic status and macroeconomic factors of a nation. Therefore, the researchers’ discovery should be taken into consideration whenever clinical studies are conducted regarding alloHCT.
Link:theoncologist.onlinelibrary.wiley.com/doi/10.1634/theoncologist.2015-0314
