Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia

Author:

Giebel Sebastian1,Labopin Myriam2,Ehninger Gerhard3,Beelen Dietrich4,Blaise Didier5,Ganser Arnold6,Bacigalupo Andrea7,Czerw Tomasz8,Holowiecki Jerzy1,Fagundes Evandro M.9,Nowara Elzbieta1,Frassoni Francesco10,Rocha Vanderson211,

Affiliation:

1. Department of Clinical and Experimental Oncology, Division of Bone Marrow Transplantation and Lymphoma, Comprehensive Cancer Centre, Maria Sklodowska-Curie Memorial Institute-Gliwice Branch, Gliwice, Poland;

2. European Group for Blood and Marrow Transplantation, Acute Leukemia Working Party, Hopital Saint-Antoine, Assistance Publique–Hopitaux de Paris (AP-HP) and Université de Paris 6, Pierre et Marie Curie, Paris, France;

3. Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany;

4. Department of Bone Marrow Transplantation, University Hospital, Essen, Germany;

5. Unité de transplantation et de thérapie cellulaire, Inserm Unite Mixte de Recherche 891, Institut Paoli Calmettes, Marseille, France;

6. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany;

7. Department of Hematology and Bone Marrow Transplantation, San Martino Hospital, Genoa, Italy;

8. Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland;

9. Department of Hematology, Federal University of Minas Gerais, Belo Horizonte, Brazil;

10. Stem Cells and Cell Therapy Centre, San Martino Hospital, Genoa, Italy; and

11. Department of Hematology, Hôpital Saint-Louis, AP-HP, Paris, France

Abstract

Abstract Human Development Index (HDI) is used by the United Nations Organization to measure socioeconomic achievements of countries. We evaluated the association of HDI with rates and outcomes of hematopoietic stem cell transplantation (HSCT) for patients with acute leukemia. For the analysis of HSCT rates, all adults with acute leukemia (n = 16 403) treated in 30 European countries, between 2001 and 2005, were included. Association of HDI with the outcome was analyzed for 2015 patients with acute myeloid leukemia treated with myeloablative allotransplantation. Countries were classified according to HDI quintiles. Highly significant correlation was found for HDI and the total number of HSCT per population (R = 0.78; P < .001), as well as separately for sibling HSCT (R = 0.84; P < .001), unrelated HSCT (R = 0.66; P < .001), and autologous HSCT (R = 0.43; P = .02). The probabilities of leukemia-free survival for 5 consecutive groups of countries with increasing HDI were: 56%, 59%, 63%, 58%, and 68% (P = .01). In a multivariate analysis, transplantations performed in countries belonging to the upper HDI category were associated with higher leukemia-free survival compared with the remaining ones (HR = 1.36, P = .008), which resulted mainly from reduced risk of relapse (HR = 0.72, P = .04). We conclude that, in Europe, the HDI is associated with both rates and results of HSCT for acute leukemia.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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