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

William A. Wood*, Ruta Brazauskas, Zhen Huan Hu, Hisham Abdel-Azim, Ibrahim A. Ahmed, Mahmoud Aljurf, Sherif Badawy, Amer Beitinjaneh, Biju George, David Buchbinder, Jan Cerny, Laurence Dedeken, Miguel Angel Diaz, Cesar O. Freytes, Siddhartha Ganguly, Usama Gergis, David Gomez Almaguer, Ashish Gupta, Gregory Hale, Shahrukh K. HashmiYoshihiro Inamoto, Rammurti T. Kamble, Kehinde Adekola, Tamila Kindwall-Keller, Jennifer Knight, Lalit Kumar, Yachiyo Kuwatsuka, Jason Law, Hillard M. Lazarus, Charles LeMaistre, Richard F. Olsson, Michael A. Pulsipher, Bipin N. Savani, Kirk R. Schultz, Ayman A. Saad, Matthew Seftel, Sachiko Seo, Thomas C. Shea, Amir Steinberg, Keith Sullivan, David Szwajcer, Baldeep Wirk, Jean Yared, Agnes Yong, Jignesh Dalal, Theresa Hahn, Nandita Khera, Carmem Bonfim, Yoshiko Atsuta, Wael Saber

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1928-1935
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number9
DOIs
StatePublished - Sep 2018

Fingerprint

Cell Transplantation
Human Development
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Cell Survival
Transplants
Survival
Transplantation
Health Expenditures
Proportional Hazards Models
Bone Marrow
Economics
Confidence Intervals
Delivery of Health Care
Mortality
Research

Keywords

  • Bone marrow
  • Health expenditures
  • Hematopoietic stem cell transplantation
  • Outcome assessment (Health care)
  • Precursor cell lymphoblastic leukemia-lymphoma

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Wood, William A. ; Brazauskas, Ruta ; Hu, Zhen Huan ; Abdel-Azim, Hisham ; Ahmed, Ibrahim A. ; Aljurf, Mahmoud ; Badawy, Sherif ; Beitinjaneh, Amer ; George, Biju ; Buchbinder, David ; Cerny, Jan ; Dedeken, Laurence ; Diaz, Miguel Angel ; Freytes, Cesar O. ; Ganguly, Siddhartha ; Gergis, Usama ; Almaguer, David Gomez ; Gupta, Ashish ; Hale, Gregory ; Hashmi, Shahrukh K. ; Inamoto, Yoshihiro ; Kamble, Rammurti T. ; Adekola, Kehinde ; Kindwall-Keller, Tamila ; Knight, Jennifer ; Kumar, Lalit ; Kuwatsuka, Yachiyo ; Law, Jason ; Lazarus, Hillard M. ; LeMaistre, Charles ; Olsson, Richard F. ; Pulsipher, Michael A. ; Savani, Bipin N. ; Schultz, Kirk R. ; Saad, Ayman A. ; Seftel, Matthew ; Seo, Sachiko ; Shea, Thomas C. ; Steinberg, Amir ; Sullivan, Keith ; Szwajcer, David ; Wirk, Baldeep ; Yared, Jean ; Yong, Agnes ; Dalal, Jignesh ; Hahn, Theresa ; Khera, Nandita ; Bonfim, Carmem ; Atsuta, Yoshiko ; Saber, Wael. / Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia : A CIBMTR Analysis. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 9. pp. 1928-1935.
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abstract = "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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author = "Wood, {William A.} and Ruta Brazauskas and Hu, {Zhen Huan} and Hisham Abdel-Azim and Ahmed, {Ibrahim A.} and Mahmoud Aljurf and Sherif Badawy and Amer Beitinjaneh and Biju George and David Buchbinder and Jan Cerny and Laurence Dedeken and Diaz, {Miguel Angel} and Freytes, {Cesar O.} and Siddhartha Ganguly and Usama Gergis and Almaguer, {David Gomez} and Ashish Gupta and Gregory Hale and Hashmi, {Shahrukh K.} and Yoshihiro Inamoto and Kamble, {Rammurti T.} and Kehinde Adekola and Tamila Kindwall-Keller and Jennifer Knight and Lalit Kumar and Yachiyo Kuwatsuka and Jason Law and Lazarus, {Hillard M.} and Charles LeMaistre and Olsson, {Richard F.} and Pulsipher, {Michael A.} and Savani, {Bipin N.} and Schultz, {Kirk R.} and Saad, {Ayman A.} and Matthew Seftel and Sachiko Seo and Shea, {Thomas C.} and Amir Steinberg and Keith Sullivan and David Szwajcer and Baldeep Wirk and Jean Yared and Agnes Yong and Jignesh Dalal and Theresa Hahn and Nandita Khera and Carmem Bonfim and Yoshiko Atsuta and Wael Saber",
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Wood, WA, Brazauskas, R, Hu, ZH, 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 2018, 'Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis', Biology of Blood and Marrow Transplantation, vol. 24, no. 9, pp. 1928-1935. https://doi.org/10.1016/j.bbmt.2018.03.016

Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia : A CIBMTR Analysis. / Wood, William A.; Brazauskas, Ruta; Hu, Zhen Huan; Abdel-Azim, Hisham; Ahmed, Ibrahim A.; Aljurf, Mahmoud; Badawy, Sherif; Beitinjaneh, Amer; George, Biju; Buchbinder, David; Cerny, Jan; Dedeken, Laurence; Diaz, Miguel Angel; Freytes, Cesar O.; Ganguly, Siddhartha; Gergis, Usama; Almaguer, David Gomez; Gupta, Ashish; Hale, Gregory; Hashmi, Shahrukh K.; Inamoto, Yoshihiro; Kamble, Rammurti T.; Adekola, Kehinde; Kindwall-Keller, Tamila; Knight, Jennifer; Kumar, Lalit; Kuwatsuka, Yachiyo; Law, Jason; Lazarus, Hillard M.; LeMaistre, Charles; Olsson, Richard F.; Pulsipher, Michael A.; Savani, Bipin N.; Schultz, Kirk R.; Saad, Ayman A.; Seftel, Matthew; Seo, Sachiko; Shea, Thomas C.; Steinberg, Amir; Sullivan, Keith; Szwajcer, David; Wirk, Baldeep; Yared, Jean; Yong, Agnes; Dalal, Jignesh; Hahn, Theresa; Khera, Nandita; Bonfim, Carmem; Atsuta, Yoshiko; Saber, Wael.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 9, 09.2018, p. 1928-1935.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia

T2 - A CIBMTR Analysis

AU - Wood, William A.

AU - Brazauskas, Ruta

AU - Hu, Zhen Huan

AU - Abdel-Azim, Hisham

AU - Ahmed, Ibrahim A.

AU - Aljurf, Mahmoud

AU - Badawy, Sherif

AU - Beitinjaneh, Amer

AU - George, Biju

AU - Buchbinder, David

AU - Cerny, Jan

AU - Dedeken, Laurence

AU - Diaz, Miguel Angel

AU - Freytes, Cesar O.

AU - Ganguly, Siddhartha

AU - Gergis, Usama

AU - Almaguer, David Gomez

AU - Gupta, Ashish

AU - Hale, Gregory

AU - Hashmi, Shahrukh K.

AU - Inamoto, Yoshihiro

AU - Kamble, Rammurti T.

AU - Adekola, Kehinde

AU - Kindwall-Keller, Tamila

AU - Knight, Jennifer

AU - Kumar, Lalit

AU - Kuwatsuka, Yachiyo

AU - Law, Jason

AU - Lazarus, Hillard M.

AU - LeMaistre, Charles

AU - Olsson, Richard F.

AU - Pulsipher, Michael A.

AU - Savani, Bipin N.

AU - Schultz, Kirk R.

AU - Saad, Ayman A.

AU - Seftel, Matthew

AU - Seo, Sachiko

AU - Shea, Thomas C.

AU - Steinberg, Amir

AU - Sullivan, Keith

AU - Szwajcer, David

AU - Wirk, Baldeep

AU - Yared, Jean

AU - Yong, Agnes

AU - Dalal, Jignesh

AU - Hahn, Theresa

AU - Khera, Nandita

AU - Bonfim, Carmem

AU - Atsuta, Yoshiko

AU - Saber, Wael

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

KW - Bone marrow

KW - Health expenditures

KW - Hematopoietic stem cell transplantation

KW - Outcome assessment (Health care)

KW - Precursor cell lymphoblastic leukemia-lymphoma

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