在加利福尼亚州新诊断的急性髓样白血病患者中利用同种异体造血干细胞移植：一项基于人群的链接数据集研究
Utilization of allogeneic hematopoietic stem cell transplantation among patients with newly diagnosed acute myeloid leukemia in California: a population-based linked dataset study
影响因子:7.90000
分区:医学1区 Top / 血液学2区
发表日期:2025 Feb 01
作者:
Christa L Meyer, Theresa H M Keegan, Ann Brunson, Jeffery J Auletta, Lindsay M Morton, Ted Wun, Sara J Schonfeld, Bryan Valcarcel, Renata Abrahão, Rafeek A Yusuf, Lori Muffly
摘要
急性髓样白血病（AML）通常需要同种异体造血细胞移植（AllOHCT）来治愈，但从历史上讲，AllOHCT已被明显不足。这样的原因在人口层面仍然不确定。我们检查了随着时间的流逝的AllOHCT利用，并探索了人口 /医疗保健因素之间的关联以及按年龄组（青少年 /年轻成人[AYA] 15-39岁，成人40-64岁，老年人65-79岁），使用链接的数据集使用链接的数据集合并国际血液和莫罗夫移植研究中心，加利福尼亚州和加州癌症患者。资格包括2001 - 2016年接受诱导疗法且没有先前HCT的患者在加利福尼亚州新诊断为AML的患者。多变量的高灰色回归分析分别在年龄组之间分别拟合。在7,925例AML患者中，所有年龄段的AllOHCT利用率随时间增加；然而，在最近研究的最新时期（2011-2016）中，相对于成年人（41％）和AYA（49％）的老年人（13％）的诊断后两年内的利用率仍然最低。统计学上与较低的AllOHCT利用相关的因素是：1）AYA：女性，较低的社区社会经济地位（NSES），未保险或印度卫生服务（IHS）的覆盖范围； 2）成年人：年龄较大，男性，非西班牙裔黑人或亚洲种族和种族，未婚，下NSE，未保险或由医疗补助，医疗保险或IHS覆盖，合并症较高，距离移植中心100多英里； 3）老年人：年龄较大，亚洲种族和未婚。总之，使用基于人群的链接数据集，我们证明，在加利福尼亚州，新诊断为AML的老年患者中AllOHCT的利用在加利福尼亚州仍然很低，并且与利用率相关的因素因年龄段而异。
Abstract
Acute myeloid leukemia (AML) often requires allogeneic hematopoietic cell transplantation (alloHCT) for cure, but historically alloHCT has been strikingly underutilized. Reasons for this remain uncertain at the population level. We examined alloHCT utilization over time and explored associations between demographic / healthcare factors and use of alloHCT by age group (adolescent / young adult [AYA] 15-39 years, adult 40-64 years, older adult 65-79 years) using a linked dataset merging the Center for Internatonal Blood and Marrow Transplant Research, the California Cancer Registry, and the California Patient Discharge Database. Eligibility included patients newly diagnosed with AML in California between 2001-2016 who received induction therapy and had no prior HCT. Multivariable Fine-Gray regression analyses were fitted separately across age groups. Among 7,925 patients with AML, alloHCT utilization increased over time across all age groups; however, in the most recent time period studied (2011-2016), utilization within two years of diagnosis remained lowest in older adults (13%) relative to adults (41%) and AYA (49%). Factors statistically significantly associated with lower alloHCT utilization were: 1) AYA: female sex, lower neighborhood socioeconomic status (nSES), uninsured or Indian Health Services (IHS) coverage; 2) adults: older age, male sex, non-Hispanic Black or Asian race and ethnicity, unmarried, lower nSES, uninsured or covered by Medicaid, Medicare, or IHS, higher comorbidity, and living 100+ miles from a transplant center; and 3) older adults: older age, Asian race, and unmarried. In conclusion, using a population-based linked dataset, we demonstrate that utilization of alloHCT among older patients newly diagnosed with AML remains low in California, and factors associated with utilization vary by age group.