加州新诊断急性髓系白血病患者的异基因造血干细胞移植利用情况：一项基于人群的关联数据集研究

Utilization of allogeneic hematopoietic stem cell transplantation among patients with newly diagnosed acute myeloid leukemia in California: a population-based linked dataset study

HAEMATOLOGICA

影响因子:7.9

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

DOI: 10.3324/haematol.2024.285648

摘要

急性髓系白血病（AML）通常需要异基因造血细胞移植（alloHCT）以实现治愈，但历史上alloHCT的应用明显不足。其原因在群体层面尚不明确。我们使用合并了血液与骨髓移植研究中心（CIBMTR）、加州癌症登记处（California Cancer Registry）和加州患者出院数据库的关联数据集，分析了不同年龄组（青少年/青年成人15-39岁、成人40-64岁、高龄成人65-79岁）中alloHCT的利用变化及其与人口统计/医疗因素的关系。研究对象为2001-2016年在加州新诊断AML且接受诱导治疗、无既往HCT的患者。采用多变量Fine-Gray回归模型，分别分析各年龄组。在7925例AML患者中，所有年龄组的alloHCT利用率均随着时间推移而增加；但在最新的研究时期（2011-2016年），诊断后两年内的利用率在高龄成人中最低（13%），而成人（41%）和青少年/青年成人（49%）则较高。统计学显著影响因素包括：青少年/青年成人：女性、较低的社区社会经济地位（nSES）、无保险或使用印第安健康服务（IHS）；成人：年龄较大、男性、非西班牙裔黑人或亚裔、未婚、nSES较低、无保险或依赖Medicaid、Medicare或IHS、较多合并症、距离移植中心100英里以上；高龄成人：年龄较大、亚裔、未婚。结论：利用人口基础关联数据，显示在加州，老年新诊断AML患者中alloHCT的利用率仍然偏低，且影响因素因年龄组而异。

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.