Social vulnerability and risk of non-relapse mortality after allogeneic hematopoietic cell transplantation
Menée aux Etats-Unis à partir de données portant sur 1 602 patients atteints d'un cancer et ayant reçu une greffe allogénique de cellules souches hématopoïétiques, cette étude analyse l'association entre des indicateurs de vulnérabilité sociale et la mortalité à 1 an sans récidive de la maladie
Background : Risk of non-relapse mortality (NRM) after hematopoietic cell transplantation (HCT) is high. Patient-level clinical prediction models such as the HCT-comorbidity index (HCT-CI) help identify those at increased risk for NRM, but the independent contribution of social determinants of health on HCT outcomes is not well characterized. Methods : This study included 1,602 patients who underwent allogeneic HCT between 2013–2019 at City of Hope. Census tract-level social vulnerability was measured using the Social Vulnerability Index (SVI). Fine-Gray multivariable regression evaluated the association between SVI and 1-year NRM. Subgroup analysis examined risk of NRM across combined SVI and HCT-CI categories, and by race and ethnicity. Results : Cumulative incidence of 1-year NRM after HCT was 15.3% (95% confidence interval [CI] 13.6–17.1). In multivariable analysis, patients in the highest SVI tertile (highest social vulnerability) had a 1.4-fold risk (subdistribution hazard ratio [sHR]=1.36, 95%CI 1.04–1.78) of NRM compared to individuals in the lower tertiles; patients in the highest SVI tertile who also had elevated (≥3) HCT-CI scores had the highest risk (sHR = 1.81, 95%CI 1.26–2.58) of 1-year NRM (reference: lower SVI tertiles and HCT-CI <3). High social vulnerability was associated with risk of 1-year NRM in Asian (sHR = 2.03, 95%CI 1.09–3.78) and Hispanic (sHR = 1.63, 95%CI 1.04–2.55), but not non-Hispanic White patients. Conclusions : High social vulnerability independently associated with 1-year NRM after HCT, specifically among minority populations and those with a high comorbidity burden at HCT. These findings may inform targeted approaches for needs assessment during and after HCT, allowing for timely interventions to improve health outcomes in at-risk patients.