The impact of socio‐economic factors on treatment choice and mortality in chronic myeloid leukaemia

Larfors, Gunnar; Sandin, Fredrik; Richter, Johan; Själander, Anders; Stenke, Leif; Lambe, Mats; Höglund, Martin

doi:10.1111/ejh.12845

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…Hence, the background mortality has limited impact on the survival among our patients. Furthermore, in a previous study on chronic myeloid leukaemia, 33 we found similar associations between socioeconomic factors and survival, but these associations could entirely be explained by differences in age, sex and comorbidity index. In the present data, the associations remain in spite of such adjustments, leading us to believe that there is a true relationship.…”

Section: Discussionsupporting

confidence: 76%

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Larfors

Berggren

Garelius

et al. 2021

European J of Haematology

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Objectives To assess whether socioeconomic indices such as income and educational level can explain part of the variation in survival among patients with myelodysplastic syndromes, and further to assess whether these factors influence care and treatment decisions. Methods Population‐based cohort study on 2945 Swedish patients diagnosed between 2009 and 2018 and included in the Swedish MDS Register. Relative mortality was assessed by Cox regression, whereas treatment differences were assessed by Poisson regression. Regarding mortality, patients were also compared to a matched comparison group from the general population. Results Mortality was 50% higher among patients in the lowest income category compared to the highest and 40% higher in patients with mandatory school education only compared to those with college or university education. Treatment with hypomethylating agents and allogeneic stem cell transplantation, as well as investigation with cytogenetic diagnostics were also linked to income and education. The findings were not explained by differences in risk class or comorbidity at the time of diagnosis. Conclusions Income and education are linked to survival among patients with myelodysplastic syndromes. Socioeconomic status also seems to influence treatment intensity as patients with less income and education to a lesser degree receive hypomethylating agents and transplants.

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Section: Discussionsupporting

confidence: 76%

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Larfors

Berggren

Garelius

et al. 2021

European J of Haematology

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“…In CML, socioeconomic conditions were associated with lower survival 13 . Nevertheless, income and education variables did not have an impact on the prognosis in countries with small socioeconomic disparities, regular access to health care, low drug costs and high adherence rates 14 . A Brazilian study with 103 patients showed that a low education level impairs the achievement of a complete cytogenetic response, while income or distance from the home to the health service does not influence the same 11 .…”

Section: Discussionmentioning

confidence: 96%

Incidence and spatial distribution of Chronic Myeloid Leukemia by regions of economic development in the state of Pernambuco, Brazil

Neves¹,

Brito²,

Vasconcelos

et al. 2019

Hematology, Transfusion and Cell Therapy

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Background The establishment of regional development poles in the State of Pernambuco, Brazil was characterized by industrial expansion and consequent concerns about the increase in the occurrence of diseases, specifically those having long latency periods, as is the case of Chronic Myeloid Leukemia. Methods The study included 367 patients diagnosed with Chronic Myeloid Leukemia over a ten-year period at a reference treatment center. Records of patient charts and the TerraView software were used, respectively, for data collection and geographic mapping of the cases from the twelve established State development regions. Results A total incidence of 3.4 cases per 100,000 inhabitants was found, with a predominance of the disease among males, a median age of 47 years, a mestizo ethnicity, with elementary schooling and residence in urban area. Microregional incidence varied, but there was no significant variation in numbers over the years, and no relevant socio-environmental determinants were identified. Conclusion The present study determined the incidence and characterized the spatial distribution of Chronic Myeloid Leukemia cases over a decade in a northeastern Brazilian state. The variation in the incidence rate by region of development is compatible with a homogeneous distribution of the cases. The work is a baseline study to be used for present and future analyses of the impact of the state economic development poles and the occurrence of this chronic malignant disease.

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“…Current models such as Sokal, Euro, EUTOS, and ELTS scores predict TKI treatment response and outcomes based on the clinical characteristics of patients, WBC count at initial diagnosis, HGB, comorbidities, BCR::ABL transcript types, and high-risk additional chromosomal abnormalities. Previous studies have confirmed that sociodemographic factors are significantly associated with the prognosis of patients with chronic myeloid leukemia (23)(24)(25)(26)(27)(28). Therefore, in this model, sociodemographic factors were considered, including patient age, sex, annual household income, marital status, level of education, household registration, and other factors.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to predict poor efficacy of imatinib in the treatment of newly diagnosed chronic phase chronic myeloid leukemia patients

Li,

Zhang,

Wang

et al. 2024

Front. Oncol.

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BackgroundImatinib is the most widely used tyrosine kinase inhibitor (TKI) in patients with newly diagnosed chronic-phase chronic myeloid leukemia(CML-CP). However, failure to achieve optimal response after imatinib administration, and subsequent switch to second-generation TKI therapy results in poor efficacy and induces drug resistance. In the present study, we developed and validated a nomogram to predict the efficacy of imatinib in the treatment of patients newly diagnosed with CML-CP in order to help clinicians truly select patients who need 2nd generation TKI during initial therapy and to supplement the risk score system.MethodsWe retrospectively analyzed 156 patients newly diagnosed with CML-CP who met the inclusion criteria and were treated with imatinib at the Second Affiliated Hospital of Xi’an Jiao Tong University from January 2012 to June 2022. The patients were divided into a poor-response cohort (N = 60)and an optimal-response cohort (N = 43) based on whether they achieved major molecular remission (MMR) after 12 months of imatinib treatment. Using univariate and multivariate logistic regression analyses, we developed a chronic myeloid leukemia imatinib-poor treatment (CML-IMP) prognostic model using a nomogram considering characteristics like age, sex, HBG, splenic size, and ALP. The CML-IMP model was internally validated and compared with Sokal, Euro, EUTOS, and ELTS scores.ResultsThe area under the curve of the receiver operator characteristic curve (AUC)of 0.851 (95% CI 0.778–0.925) indicated satisfactory discriminatory ability of the nomogram. The calibration plot shows good consistency between the predicted and actual observations. The net reclassification index (NRI), continuous NRI value, and the integrated discrimination improvement (IDI) showed that the nomogram exhibited superior predictive performance compared to the Sokal, EUTOS, Euro, and ELTS scores (P < 0.05). In addition, the clinical decision curve analysis (DCA) showed that the nomogram was useful for clinical decision-making. In predicting treatment response, only Sokal and CML-IMP risk stratification can effectively predict the cumulative acquisition rates of CCyR, MMR, and DMR (P<0.05).ConclusionWe constructed a nomogram that can be effectively used to predict the efficacy of imatinib in patients with newly diagnosed CML-CP based on a single center, 10-year retrospective cohort study.

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The impact of socio‐economic factors on treatment choice and mortality in chronic myeloid leukaemia

Abstract: In conclusion, socio-economic conditions were associated with survival in the studied CML cohort but these associations could be explained by differences at baseline. Meanwhile, socio-economic conditions appeared to influence treatment choice.

Cited by 10 publications

References 26 publications

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Income, education and their impact on treatments and survival in patients with myelodysplastic syndromes

Incidence and spatial distribution of Chronic Myeloid Leukemia by regions of economic development in the state of Pernambuco, Brazil

Development and validation of a nomogram to predict poor efficacy of imatinib in the treatment of newly diagnosed chronic phase chronic myeloid leukemia patients

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