Journal
CANCER
Volume 127, Issue 4, Pages 609-618Publisher
WILEY
DOI: 10.1002/cncr.33232
Keywords
allogeneic transplant; community health; hematopoietic cell transplantation; survival
Categories
Funding
- National Cancer Institute [R01-CA215134, U24CA076518, U24HL138660]
- National Heart, Lung, and Blood Institute [U24CA076518, U24HL138660, OT3HL147741, R21HL140314, U01HL128568]
- National Institute of Allergy and Infectious Diseases [U24CA076518]
- Health Resources and Services Administration [HHSH250201700006C, SC1MC31881-01-00, HHSH250201700007C]
- Office of Naval Research [N00014-18-1-2850, N00014-18-1-2888, N00014-20-1-2705]
- Be the Match Foundation
- Boston Children's Hospital
- Dana-Farber
- Japan Hematopoietic Cell Transplantation Data Center
- National Marrow Donor Program
- Medical College of Wisconsin
- AbbVie
- Actinium Pharmaceuticals, Inc
- Adaptive Biotechnologies
- Adienne SA
- AlloVir, Inc
- Amgen, Inc
- Anthem, Inc
- Astellas Pharma US
- AstraZeneca
- Atara Biotherapeutics, Inc
- Bluebird Bio, Inc
- Bristol-Myers Squibb Co
- Celgene Corp
- Chimerix, Inc
- CSL
- St. Baldrick's Foundation
- Biomedical Advanced Research and Development Authority
- [P01CA111412]
- [R01CA152108]
- [R01CA215134]
- [R01CA218285]
- [R01CA231141]
- [R01HL126589]
- [R01AI128775]
- [R01HL129472]
- [R01HL130388]
- [R01HL131731]
- [U01AI069197]
- [U01AI126612]
Ask authors/readers for more resources
This study analyzed the impact of community health status on allogeneic HCT outcomes using data from CHRR and CIBMTR, finding that patients residing in counties with a worse community health status have inferior survival due to increased risk of NRM after allogeneic HCT. There was no significant 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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