Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
Biol Blood Marrow Transplant. 2018 Sep;24(9):1928-1935. doi: 10.1016/j.bbmt.2018.03.016. Epub 2018 Mar 19.
For patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (alloHCT) offers a potential cure. Life-threatening complications can arise from alloHCT that require the application of sophisticated health care delivery. The impact of country-level economic conditions on post-transplantation outcomes is not known. Our objective was to assess whether these variables were associated with outcomes for patients transplanted for ALL. Using data from the Center for Blood and Marrow Transplant Research, we included 11,261 patients who received a first alloHCT for ALL from 303 centers across 38 countries between the years of 2005 and 2013. Cox regression models were constructed using the following macroeconomic indicators as main effects: Gross national income per capita, health expenditure per capita, and Human Development Index (HDI). The outcome was overall survival at 100 days following transplantation. In each model, transplants performed within lower resourced environments were associated with inferior overall survival. In the model with the HDI as the main effect, transplants performed in the lowest HDI quartile (n = 697) were associated with increased hazard for mortality (hazard ratio, 2.42; 95% confidence interval, 1.64 to 3.57; P < .001) in comparison with transplants performed in the countries with the highest HDI quartile. This translated into an 11% survival difference at 100 days (77% for lowest HDI quartile versus 88% for all other quartiles). Country-level macroeconomic indices were associated with lower survival at 100 days after alloHCT for ALL. The reasons for this disparity require further investigation.
对于急性淋巴细胞白血病（ALL）患者，同种异体造血细胞移植（alloHCT）提供了一种潜在的治愈方法。alloHCT 可能会导致危及生命的并发症，需要应用复杂的医疗保健服务。但目前尚不清楚国家经济状况对移植后结果的影响。我们的目的是评估这些变量是否与 ALL 患者的移植结果相关。我们使用了血液和骨髓移植研究中心的数据，纳入了 38 个国家的 303 个中心在 2005 年至 2013 年间进行的首次用于 ALL 的 alloHCT 的 11261 名患者。使用以下宏观经济指标作为主要效应构建了 Cox 回归模型：人均国民总收入、人均卫生支出和人类发展指数（HDI）。结果是移植后 100 天的总生存率。在每个模型中，在资源较少的环境中进行的移植与整体生存率降低相关。在以 HDI 作为主要效应的模型中，在 HDI 最低四分位数（n=697）中进行的移植与死亡率增加的风险相关（危险比，2.42；95%置信区间，1.64 至 3.57；P<.001）与在 HDI 最高四分位数的国家中进行的移植相比。这转化为 100 天时的生存率差异为 11%（最低 HDI 四分位数为 77%，所有其他四分位数为 88%）。国家层面的宏观经济指数与 alloHCT 后 ALL 患者 100 天生存率降低相关。这种差异的原因需要进一步调查。
