Costa Luciano J, Huang Jia-Xing, Hari Parameswaran N
Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant. 2015 Apr;21(4):701-6. doi: 10.1016/j.bbmt.2014.12.024. Epub 2014 Dec 30.
Autologous hematopoietic cell transplantation (AHCT) is an established therapy for multiple myeloma (MM), with an impact on quality of remission and survival. We analyzed the role of race, ethnicity, sex, and age disparities in AHCT utilization in the United States. We combined MM incidence derived from the Surveillance, Epidemiology and End Results program with transplantation activity reported to the Center for International Blood and Marrow Transplant Research for the period of 2005 to 2009 to assess the impact of disparities in AHCT. Utilization (number of transplantations/new cases) was compared between groups using the relative utilization ratio (RUR), defined as [utilization for a given category]/[utilization for the entire population]. Data were obtained from 22,462 actual MM cases and 13,311 AHCT. The age-adjusted RUR was 1.17 (95% confidence interval [CI], 1.15 to 1.19) among non-Hispanic Whites (NHW), higher than in non-Hispanic Blacks (NHB) (age-adjusted RUR, .69; 95% CI, .67 to .72; P < .0002), Hispanics (age-adjusted RUR, .64; 95% CI, .60 to .69; P < .002), and Asians (age-adjusted RUR, .65; 95% CI, .58 to .73; P < .0002]. AHCT utilization was higher in men than in women among Hispanics (age-adjusted RUR .72 versus .56, P = .007), but not among NHW, NHB, or Asians. Sex disparity prevents 1.3% of potential AHCTs in patients with MM (10.4% among Hispanics). Racial-ethnic disparities prevent 13.8% of AHCTs (44.7% in Hispanic and Asians, 39.9% in NHBs). Race-ethnicity disparity greatly affects AHCT utilization in MM. Sex disparity plays a lesser role, except among Hispanics. The ongoing decrease in age disparity will continue to drive major increase of AHCT activity. Two-year and 5-year increases in the age of the AHCT population would result in 12% and 32% increases, respectively, in volume of AHCT.
自体造血细胞移植（AHCT）是一种用于治疗多发性骨髓瘤（MM）的既定疗法，对缓解质量和生存率有影响。我们分析了种族、民族、性别和年龄差异在美国AHCT应用中的作用。我们将监测、流行病学和最终结果计划得出的MM发病率与2005年至2009年期间报告给国际血液和骨髓移植研究中心的移植活动相结合，以评估AHCT差异的影响。使用相对利用率（RUR）比较各组之间的利用率（移植次数/新病例数），RUR定义为[给定类别的利用率]/[整个人口的利用率]。数据来自22462例实际MM病例和13311例AHCT。非西班牙裔白人（NHW）的年龄调整后RUR为1.17（95%置信区间[CI]，1.15至1.19），高于非西班牙裔黑人（NHB）（年龄调整后RUR，0.69；95%CI，0.67至0.72；P<.0002）、西班牙裔（年龄调整后RUR，0.64；95%CI，0.60至0.69；P<.002）和亚洲人（年龄调整后RUR，0.65；95%CI，0.58至0.73；P<.0002）。在西班牙裔中，男性的AHCT利用率高于女性（年龄调整后RUR为0.72对0.56，P=.007），但在NHW、NHB或亚洲人中并非如此。性别差异导致MM患者中1.3%的潜在AHCT无法进行（西班牙裔中为10.4%）。种族-民族差异导致13.8%的AHCT无法进行（西班牙裔和亚洲人为44.7%，NHB为39.9%）。种族-民族差异极大地影响了MM中AHCT的应用。性别差异的作用较小，西班牙裔除外。年龄差异的持续缩小将继续推动AHCT活动的大幅增加。AHCT人群年龄增加两岁和五岁将分别导致AHCT数量增加12%和32%。
