Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT
A partir de données portant sur 983 patients atteints d'une leucémie lymphoblastique aiguë dans 24 pays européens, cette étude évalue les effets de divers facteurs macro-économiques sur la survie sans récidive et la survie globale, après une greffe allogénique de cellules souches hématopoïétiques (dépenses de soins de santé, indice de développement humain, niveau de pratique professionnelle des centres hospitaliers)
From a global perspective, the rates of allogeneic hematopoietic cell transplantation (alloHCT) are closely related to the economic status of a country. However, a potential association with outcome has not yet been documented. The goal of this study was to evaluate effects of health care expenditure (HCE), Human Development Index (HDI), team density, and center experience on nonrelapse mortality (NRM) after HLA-matched sibling alloHCT for adults with acute lymphoblastic leukemia (ALL).A total of 983 patients treated with myeloablative alloHCT between 2004 and 2008 in 24 European countries were included.In a univariate analysis, the probability of day 100 NRM was increased for countries with lower current HCE (8% vs. 3%; p = .06), countries with lower HDI (8% vs. 3%; p = .02), and centers with less experience (8% vs. 5%; p = .04). In addition, the overall NRM was increased for countries with lower current HCE (21% vs. 17%; p = .09) and HDI (21% vs. 16%; p = .03) and for centers with lower activity (21% vs. 16%; p = .07). In a multivariate analysis, the strongest predictive model for day 100 NRM included current HCE greater than the median (hazard ratio [HR], 0.39; p = .002). The overall NRM was mostly predicted by HDI greater than the median (HR, 0.65; p = .01). Both lower current HCE and HDI were associated with decreased probability of overall survival.Both macroeconomic factors and the socioeconomic status of a country strongly influence NRM after alloHCT for adults with ALL. Our findings should be considered when clinical studies in the field of alloHCT are interpreted.Results of allogeneic hematopoietic cell transplantation (alloHCT) and other advanced oncological procedures may vary among countries and be related to various economic factors. This study, which included a homogenous population of patients with acute lymphoblastic leukemia, demonstrated significant associations of health care expenditure and the Human Development Index with nonrelapse mortality and overall survival after transplantation. The findings should be taken into account when clinical studies in the field of alloHCT are interpreted. The study should be followed by further investigation in other fields of oncology.
The Oncologist 2016