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Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis.

Publication ,  Journal Article
Wood, WA; Brazauskas, R; Hu, Z-H; Abdel-Azim, H; Ahmed, IA; Aljurf, M; Badawy, S; Beitinjaneh, A; George, B; Buchbinder, D; Cerny, J; Diaz, MA ...
Published in: Biol Blood Marrow Transplant
September 2018

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.

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Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

September 2018

Volume

24

Issue

9

Start / End Page

1928 / 1935

Location

United States

Related Subject Headings

  • Transplantation Conditioning
  • Survival Analysis
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Female
  • Adolescent
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Wood, W. A., Brazauskas, R., Hu, Z.-H., Abdel-Azim, H., Ahmed, I. A., Aljurf, M., … Saber, W. (2018). Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis. Biol Blood Marrow Transplant, 24(9), 1928–1935. https://doi.org/10.1016/j.bbmt.2018.03.016
Wood, William A., Ruta Brazauskas, Zhen-Huan Hu, Hisham Abdel-Azim, Ibrahim A. Ahmed, Mahmoud Aljurf, Sherif Badawy, et al. “Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis.Biol Blood Marrow Transplant 24, no. 9 (September 2018): 1928–35. https://doi.org/10.1016/j.bbmt.2018.03.016.
Wood WA, Brazauskas R, Hu Z-H, Abdel-Azim H, Ahmed IA, Aljurf M, et al. Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis. Biol Blood Marrow Transplant. 2018 Sep;24(9):1928–35.
Wood, William A., et al. “Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis.Biol Blood Marrow Transplant, vol. 24, no. 9, Sept. 2018, pp. 1928–35. Pubmed, doi:10.1016/j.bbmt.2018.03.016.
Wood WA, Brazauskas R, Hu Z-H, Abdel-Azim H, Ahmed IA, Aljurf M, Badawy S, Beitinjaneh A, George B, Buchbinder D, Cerny J, Dedeken L, Diaz MA, Freytes CO, Ganguly S, Gergis U, Almaguer DG, Gupta A, Hale G, Hashmi SK, Inamoto Y, Kamble RT, Adekola K, Kindwall-Keller T, Knight J, Kumar L, Kuwatsuka Y, Law J, Lazarus HM, LeMaistre C, Olsson RF, Pulsipher MA, Savani BN, Schultz KR, Saad AA, Seftel M, Seo S, Shea TC, Steinberg A, Sullivan K, Szwajcer D, Wirk B, Yared J, Yong A, Dalal J, Hahn T, Khera N, Bonfim C, Atsuta Y, Saber W. Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis. Biol Blood Marrow Transplant. 2018 Sep;24(9):1928–1935.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

September 2018

Volume

24

Issue

9

Start / End Page

1928 / 1935

Location

United States

Related Subject Headings

  • Transplantation Conditioning
  • Survival Analysis
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Female
  • Adolescent
  • 3201 Cardiovascular medicine and haematology