Sanghee Hong1, Ruta Brazauskas2,3, Kyle M Hebert2, Siddhartha Ganguly4, Hisham Abdel-Azim5, Miguel Angel Diaz6, Sara Beattie7,8, Stefan O Ciurea9, David Szwajcer10, Sherif M Badawy11,12, Alois A Gratwohl13, Charles LeMaistre14, Mahmoud D S M Aljurf15, Richard F Olsson16,17, Neel S Bhatt18, Nosha Farhadfar19, Jean A Yared20, Ayami Yoshimi21, Sachiko Seo22, Usama Gergis23, Amer M Beitinjaneh24, Akshay Sharma25, Hillard Lazarus26, Jason Law27, Matthew Ulrickson28, Hasan Hashem29, Hélène Schoemans30, Jan Cerny31, David Rizzieri32, Bipin N Savani33, Rammurti T Kamble34, Bronwen E Shaw2, Nandita Khera35, William A Wood36, Shahrukh Hashmi37, Theresa Hahn38, Stephanie J Lee2,18, J Douglas Rizzo2, Navneet S Majhail1, Wael Saber2. 1. Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio. 2. Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas. 5. Division of Hematology, Oncology, and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California. 6. Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain. 7. Department of Psychosocial Oncology and Rehabilitation, Tom Baker Cancer Centre, Calgary, Alberta, Canada. 8. Department of Oncology, University of Calgary, Calgary, Alberta, Canada. 9. The University of Texas MD Anderson Cancer Center, Houston, Texas. 10. University of Manitoba, Winnipeg, Manitoba, Canada. 11. Division of Hematology, Oncology, and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 12. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 13. University Hospital Basel, Basel, Switzerland. 14. Hematology and Bone Marrow Transplant, Sarah Cannon, Nashville, Tennessee. 15. Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 16. Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden. 17. Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden. 18. Fred Hutchinson Cancer Research Center, Seattle, Washington. 19. Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida. 20. Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland. 21. Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Freiburg, Germany. 22. Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan. 23. Thomas Jefferson University, Philadelphia, Pennsylvania. 24. University of Miami, Miami, Florida. 25. Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee. 26. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio. 27. Division of Pediatric Hematology/Oncology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts. 28. Banner MD Anderson Cancer Center, Gilbert, Arizona. 29. Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan. 30. Department of Hematology, University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium. 31. Division of Hematology/Oncology, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts. 32. Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina. 33. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 34. Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas. 35. Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona. 36. Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina. 37. Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. 38. Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
Abstract
BACKGROUND: The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes. METHODS: This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied. RESULTS: The median age was 55 years (range, 18-83 years). The median PCS was -0.21 (range, -1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was -0.13 (range, -1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM. CONCLUSIONS: Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.
BACKGROUND: The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes. METHODS: This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied. RESULTS: The median age was 55 years (range, 18-83 years). The median PCS was -0.21 (range, -1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was -0.13 (range, -1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P = .0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P = .0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P = .0004). CCS was not significantly associated with survival, relapse, or NRM. CONCLUSIONS: Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.
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