Department of Medicine, Division of Hematology, University of Ottawa, Ontario, Canada.
Biol Blood Marrow Transplant. 2012 May;18(5):708-15. doi: 10.1016/j.bbmt.2011.08.022. Epub 2011 Sep 8.
Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) need access to specialized care. We hypothesized that access to the transplant center after HSCT may be challenging for patients living in geographically distant areas, and that this would have an adverse effect on their outcome. We analyzed 1912 adult patients who underwent allogeneic HSCT at the Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) between 1996 and 2009 and who resided within 6 hours driving time of the institution. Driving time from primary residence to DF/BWCC based on zipcode was determined using geographic information systems. The median driving time (range) to DF/BWCC was 72 (2-358) minutes. When patients were stratified by driving time quartile, overall survival (OS) after HSCT was similar in the first year but worse after 1 year in patients in the top quartile (≥ 160 minutes driving time). In a landmark analysis of the 909 patients alive and free of disease at 1 year, 5-year OS was 76% and 65% for patients in the first (≤ 40 minutes) and fourth (≥ 160 minutes) quartiles, respectively (P = .027). This was confirmed in a multivariable analysis. The difference appeared to be mostly because of an increase in nonrelapse mortality. The number of visits to the transplant center between day 100 and 365 after HSCT declined significantly with increasing driving time to the transplant center, which was independently associated with worse survival. Long driving time to the transplant center is associated with worse OS in patients alive and disease-free 1 year after HSCT, independently of other patient-, disease-, and HSCT-related variables. This may be in part related to the lower frequency of post-HSCT visits in patients living farther away.
接受异基因造血干细胞移植（HSCT）的患者需要获得专业护理。我们假设，对于居住在地理位置偏远地区的患者来说，在 HSCT 后获得移植中心的支持可能具有挑战性，并且这会对他们的预后产生不利影响。我们分析了 1912 名于 1996 年至 2009 年期间在 Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) 接受异基因 HSCT 的成年患者，这些患者居住在距离机构 6 小时车程内。根据邮政编码，使用地理信息系统确定从主要居住地到 DF/BWCC 的驾驶时间中位数（范围）为 72（2-358）分钟。按驾驶时间四分位距分层患者时，HSCT 后第一年的总体生存率（OS）相似，但在四分位距最高的患者（≥160 分钟的驾驶时间）中，1 年后 OS 更差。在 909 名存活且无疾病 1 年的患者的里程碑分析中，OS 在第 1 四分位距（≤40 分钟）和第 4 四分位距（≥160 分钟）的患者中分别为 76%和 65%（P=0.027）。这在多变量分析中得到了证实。这种差异似乎主要是由于非复发死亡率的增加。HSCT 后 100 至 365 天期间，前往移植中心的就诊次数随着前往移植中心的驾驶时间的增加而显著减少，这与生存状况较差独立相关。前往移植中心的驾驶时间较长与 HSCT 后 1 年存活且无疾病的患者的 OS 较差独立相关，与其他患者、疾病和 HSCT 相关变量无关。这可能部分与居住在更远地方的患者接受 HSCT 后就诊次数减少有关。
