Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma

Hong, Sanghee; Rybicki, Lisa; Abounader, Donna; Bolwell, Brian J.; Dean, Robert M.; Gerds, Aaron T.; Hamilton, Betty K.; Hill, Brian T.; Jagadeesh, Deepa; Kalaycio, Matt; Liu, H. D.; Pohlman, Brad; Sobecks, Ronald; Majhail, Navneet S.

doi:10.1038/bmt.2016.107

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…As noted previously, most previous studies have shown no impact of long driving distances or rural residences on clinical outcomes after HCT [32,34,[37][38][39][40][41][42]. Our study adds to this literature by investigating driving distance and patient-reported outcomes after HCT.…”

Section: Impacts Of Driving Distance On Hct Survivorshipsupporting

confidence: 60%

“…Multiple centers have retrospectively investigated whether long driving distances or rural residences affect overall survival after HCT [ 32 , 34 , 37 , 38 , 39 , 40 , 41 , 42 ]. Although these studies have generally reported no impact of driving distances on clinical outcomes, the impact of driving distances on patient-reported outcomes (PROs) after HCT is unknown.…”

mentioning

confidence: 99%

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Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors

Banerjee

Majhail

et al. 2020

Biology of Blood and Marrow Transplantation

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Long driving distances to transplantation centers may impede access to care for hematopoietic cell transplantation (HCT) survivors. As a secondary analysis from the multicenter INSPIRE study (NCT01602211), we examined baseline data from relapse-free HCT adult survivors (2 to 10 years after allogeneic or autologous HCT) to investigate the association between driving distances and patient-reported outcome (PRO) measures of distress and physical function. We analyzed predictors of elevated distress and impaired physical function using logistic regression models that operationalized driving distance first as a continuous variable and separately as a dichotomous variable (<100 versus 100+ miles). Of 1136 patients available for analysis from 6 US centers, median driving distance was 82 miles and 44% resided 100+ miles away from their HCT centers. Elevated distress was reported by 32% of patients, impaired physical function by 19%, and both by 12%. Driving distance, whether operationalized as a continuous or dichotomous variable, had no impact on distress or physical function in linear regression modeling (95% confidence interval, 1.00 to 1.00, for both PROs with driving distance as a continuous variable). In contrast, chronic graft-versus-host-disease, lower income, and lack of Internet access independently predicted both elevated distress and impaired physical function. In summary, we found no impact of driving distance on distress and physical function among HCT survivors. Our results have implications for how long-term follow-up care is delivered after HCT, with regard to the negligible impact of driving distances on PROs and also the risk of a "digital divide" worsening outcomes among HCT survivors without Internet access.

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Section: Impacts Of Driving Distance On Hct Survivorshipsupporting

confidence: 60%

mentioning

confidence: 99%

Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors

Banerjee

Majhail

et al. 2020

Biology of Blood and Marrow Transplantation

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“…In a population-based study among 6,234 patients in Denmark diagnosed with NHL in 2000–2008, all-cause mortality was increased by 63% for patients with a short education compared with patients with higher education, and there was a significant higher frequency of intensive treatment in patients with higher education 11. In line with these findings, Hong et al showed in a retrospective single-center study among 687 patients with NHL in Ohio that a high socioeconomic position was associated with a significantly better OS (HR 0.74, 95% CI: 0.58–0.95) 12. Investigations of the impact of socioeconomic factors on treatment intensity in the relapse setting are scarce.…”

Section: Introductionmentioning

confidence: 79%

<p>Treatment intensity and survival in patients with relapsed or refractory diffuse large B-cell lymphoma in Denmark: a real-life population-based study</p>

Arboe

Olsen

Gørløv

et al. 2019

CLEP

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Purpose High-dose chemotherapy with autologous stem cell transplantation (ASCT) is considered to be the only curative treatment option for patients with refractory or relapsed diffuse large B-cell lymphoma (DLBCL). Due to toxicity, not all patients are eligible for this treatment leading to different treatment intensities. Here, we aim to analyze the impact of treatment intensity on survival in patients previously treated with rituximab and chemotherapy, and, furthermore, to analyze the association between socioeconomic position and treatment intensity, defined as palliation, non-salvage, and salvage regimens. Materials and methods We identified patients with refractory or relapsed DLBCL diagnosed in 2000–2015 in the Danish National Lymphoma Registry (n=1,228). We analyzed the impact of treatment intensity on survival in patients previously treated with rituximab (n=277) using a Cox proportional hazards model. Multinomial regression analyses were performed to identify associations between socioeconomic factors and treatment intensity for the entire cohort. Results In the rituximab era, the 5-year overall survival (OS) was 31% for patients receiving salvage regimens (n=194), and 17% for patients receiving non-salvage regimens (n=83). In the adjusted analysis, HR was 1.88, 95% CI: 0.9–3.9 for patients receiving salvage regimens. Patients living alone were significantly less likely to receive salvage regimens, as were patients with two or more comorbidities. Conclusion We observed a better OS in patients treated with salvage regimens compared with non-salvage regimens; however, the adjusted analysis contradicts this. Furthermore, our results indicate that there is a chance of remission for patients not eligible for ASCT.

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“…At a median total healthcare cost at 100 days of $289,283 for the myeloablative HSCT and $253,467 for reduced-intensity HSCT (39), allogeneic HSCT is not a viable treatment option for the nearly 37 million PLWH globally. This reason alone has weakened support of HSCT as a viable strategy for HIV cure (40)(41)(42)(43). More recently, the use of virally transduced chimeric antigen presenting autologous T-cells (CAR-T) has broadened the potential utility of immune directed anticancer therapy with approval of several agents in this class by the US FDA for the treatment of refractory leukemia and lymphoma (44).…”

Section: Hematopoietic Stem Cell Transplantation and Cellular Therapymentioning

confidence: 99%

Crossroads of Cancer and HIV-1: Pathways to a Cure for HIV

et al. 2019

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Recently, a second individual (the "London patient") with HIV-1 infection and concomitant leukemia was cured of both diseases by a conditioning myeloablative regimen followed by transplantation of stem cells bearing the homozygous CCR5 32 mutation. The substantial risks and cost associated with this procedure render it unfeasible on a large scale. This strategy also indicates that a common pathway toward a cure for both HIV and cancer may exist. Successful approaches to curing both diseases should ideally possess three components, i.e., (1) direct targeting of pathological cells (neoplastic cells in cancer and the HIV-infected reservoir cells), (2) subsequent impediment to reconstitution of the pool of pathological cells and (3) sustained, immunologic control of the disease (both diseases are characterized by detrimental immune hyper-activation that hinders successful establishment of immunity). In this review, we explore medications that are either investigational or FDA-approved anticancer treatments that may be employed to achieve the goal of curing HIV-1. These include: thioredoxin reductase inhibitors (phases 1-3), immune checkpoint inhibitors (phases 1, 3), Jak inhibitors (FDA approved for arthritis and multiple cancer indications, summarized in Table 1). Of note, some of these medications such as arsenic trioxide and Jak inhibitors may also reversibly down regulate CCR5 expression on CD4 + T-cells, thus escaping the ethical issues of inducing or transferring mutations in CCR5 that are presently the subject of interest as it relates to HIV-1 cure strategies.

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Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma

Cited by 16 publications

References 26 publications

Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors

Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors

<p>Treatment intensity and survival in patients with relapsed or refractory diffuse large B-cell lymphoma in Denmark: a real-life population-based study</p>

Crossroads of Cancer and HIV-1: Pathways to a Cure for HIV

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