Division of Pediatric Oncology, Blood and Marrow Transplant, Alberta Children's Hospital, Calgary, Alberta, Canada.
The University of Queensland, Centre for Health Services Research, Brisbane, Australia.
Pediatr Blood Cancer. 2020 Jul;67(7):e28263. doi: 10.1002/pbc.28263. Epub 2020 Apr 23.
Indications for hematopoietic stem cell transplantation (HSCT) in pediatric acute myeloid leukemia (AML) are primarily dependent on risk stratification at diagnosis and relapse status. We sought to determine whether access to HSCT is influenced by regional and socioeconomic factors.
Children with newly diagnosed AML aged < 15 years between 2001 and 2015 were identified using the Cancer in Young People in Canada national population-based registry. Factors potentially associated with the receipt of HSCT were studied using univariate and multivariable logistic regression models.
Overall, 568 children with newly diagnosed AML were included and 262 (46%) received HSCT. A greater proportion of patients, 103/157 (65.6%), underwent HSCT after first or subsequent relapse compared to 159/411 (38.7%) patients who underwent transplant before relapse. Among patients for whom HSCT would be considered before relapse, factors associated with higher odds of HSCT in a multivariable analysis were: poor versus good-risk cytogenetics (Odds ratio [OR]: 30.0, 95% confidence interval [CI]: 7.7-117.0), diagnosis during 2012-2015 versus 2001-2006 (OR: 3.2, 95% CI: 1.6-6.3), diagnosis in eastern Canada versus central Canada (OR: 3.7, 95% CI: 1.9-7.3), and age 10-14 years versus age < 1 year (OR: 5.4, 95% CI: 2.3-12.8). Among patients for whom HSCT would be considered after first relapse, higher odds of HSCT was associated with diagnosis at a HSCT center (OR: 2.1, 95% CI: 1.1-4.1).
Patients diagnosed at a HSCT performing center and patients from eastern Canada had higher odds of receiving HSCT. This may suggest preferential access to HSCT for certain patients.
儿童急性髓系白血病（AML）的造血干细胞移植（HSCT）适应证主要取决于诊断时的风险分层和复发情况。我们试图确定是否获得 HSCT 是否受到区域和社会经济因素的影响。
利用加拿大年轻人癌症全国人群登记处，确定了 2001 年至 2015 年间诊断为 AML 的 15 岁以下新发病例。使用单变量和多变量逻辑回归模型研究了可能与接受 HSCT 相关的因素。
共有 568 例新诊断为 AML 的患儿纳入研究，262 例（46%）接受了 HSCT。与首次或后续复发后接受 HSCT 的 103 例/157 例（65.6%）患儿相比，在复发前接受移植的患儿中，更多患儿（159/411 例，38.7%）接受了 HSCT。在复发前考虑 HSCT 的患儿中，多变量分析中与 HSCT 可能性更高相关的因素包括：不良风险细胞遗传学（优势比 [OR]：30.0，95%置信区间 [CI]：7.7-117.0）、2012-2015 年诊断（OR：3.2，95% CI：1.6-6.3）、加拿大东部诊断（OR：3.7，95% CI：1.9-7.3）和 10-14 岁年龄（OR：5.4，95% CI：2.3-12.8）。在首次复发后考虑 HSCT 的患儿中，更高的 HSCT 可能性与在 HSCT 中心诊断相关（OR：2.1，95% CI：1.1-4.1）。
在 HSCT 中心诊断的患者和来自加拿大东部的患者接受 HSCT 的可能性更高。这可能表明某些患者更倾向于接受 HSCT。
