Association of Outcomes and Socioeconomic Status in Mexican Patients Undergoing Allogeneic Stem Cell Transplantation

Rodríguez, Eucario León; Rivera-Franco, Mónica M.; González, María Isabel Castro

doi:10.1016/j.bbmt.2019.06.010

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Pneumonia was the most common infection; 42% pathogens were isolated (33% bacteria). It is important to highlight that in this cohort, gastroenteritis was also among the most frequent infections within this period, which could potentially be explained by the low socioeconomic status among our recipients 17 and in the country, leading to suboptimal hygienic and dietary practices.…”

Section: Discussionmentioning

confidence: 92%

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country

Rivera-Franco

Terrazas-Marín

Virgen‐Cuevas

et al. 2020

Transplant Infectious Dis

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Despite the advances in the field of hematopoietic cell transplantation (HCT), the morbidity and mortality, especially after allogeneic HCT, remain a concern. In this context, infectious diseases represent important complications after the procedure. 1,2 Different factors and clinical characteristics have been associated with the risk of infections among HCT recipients. 2 Moreover, a timeline for infections has been described based on the phases where the recipients are most vulnerable. Although artificial, due to variations in the timing and length of the intervals, the most accepted timeline for infections is preengraftment, early postengraftment, and late postengraftment, 1,2 which has proven to be helpful to manage HCT recipients. Autologous HCT recipients are mostly at risk of infections during the first two phases, whereas patients undergoing allogeneic HCT are vulnerable to infections during all three. Nonetheless, in any type of HCT, the interval of profound neutropenia is usually a period that

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Section: Discussionmentioning

confidence: 92%

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country

Rivera-Franco

Terrazas-Marín

Virgen‐Cuevas

et al. 2020

Transplant Infectious Dis

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“…To our knowledge, this analysis is the first to compare payment sources with outcomes in the Mexican population. A prior study assessed outcomes with regard to socioeconomic status, finding no difference between patient groups when social support is provided[ 16 ]. These results correlate with our findings since patients who had financial support during the times of the federal program had better outcomes than those who did not, demonstrating the positive effect of universal coverage for HSCT.…”

Section: Discussionmentioning

confidence: 99%

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

Gómez-De León,

López-Mora,

García-Zárate

et al. 2024

World J Transplant

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BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low- and middle-income countries is poorly described. This observational study analyzes the impact of place of residence, referring institution, and transplant cost coverage (out-of-pocket vs government-funded vs private insurance) on outcomes after allogeneic hematopoietic stem cell transplantation (alloHSCT) in two of Mexico's largest public and private institutions. AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico. METHODS In this retrospective cohort study, we included adolescents and adults ≥ 16 years who received a matched sibling or haploidentical transplant from 2015-2022. Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico. Three payment groups were compared: Out-of-pocket (OOP), private insurance, and a federal Universal healthcare program “Seguro Popular”. Outcomes were compared between referred and institution-diagnosed patients, and between residents of Nuevo Leon and out-of-state. Primary outcomes included overall survival (OS), categorized by residence, referral, and payment source. Secondary outcomes encompassed early mortality, event-free-survival, graft-versus-host-relapse-free survival, and non-relapse-mortality (NRM). Statistical analyses employed appropriate tests, Kaplan-Meier method, and Cox proportional hazard regression modeling. Statistical software included SPSS and R with tidycmprsk library. RESULTS Our primary outcome was overall survival. We included 287 patients, n = 164 who lived out of state (57.1%), and n = 129 referred from another institution (44.9%). The most frequent payment source was OOP (n = 139, 48.4%), followed by private insurance (n = 75, 26.1%) and universal coverage (n = 73, 25.4%). No differences in OS, event-free-survival, NRM, or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution, nor patients who lived in-state vs out-of-state. Patients who covered transplant costs through private insurance had the best outcomes with improved OS (median not reached) and 2-year cumulative incidence of NRM of 14% than patients who covered costs OOP (Median OS and 2-year NRM of 32%) or through a universal healthcare program active during the study period (OS and 2-year NRM of 19%) (P = 0.024 and P = 0.002, respectively). In a multivariate analysis, payment source and disease risk index were the only factors associated with overall survival. CONCLUSION In this Latin-American multicenter study, the site of residence or referral for alloHSCT did not impact outcomes. However, access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

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“…The IMSS (Instituto Mexicano del Seguro Social) provides healthcare to the formally employed citizens, the ISSSTE (Instituto de Seguridad y Servicio Sociales de los Trabajadores del Estado) to the bureaucrats, and the SSA (Secretaría de Salud) covers population without a formal employment. Less than 7% of Mexicans have Private healthcare ( 7 ). Currently, there are certified pediatric oncologists and certified centers in every State of the Country.…”

Section: Leukemia Treatment In Mexicomentioning

confidence: 99%

Childhood leukemias in Mexico: towards implementing CAR-T cell therapy programs

Bustamante-Ogando,

Hernández-López,

Galván-Díaz

et al. 2024

Front. Oncol.

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Leukemias are the most common type of pediatric cancer around the world. Prognosis has improved during the last decades, and many patients are cured with conventional treatment as chemotherapy; however, many patients still present with a refractory disease requiring additional treatments, including hematopoietic stem cell transplantation. Immunotherapy with monoclonal antibodies or cellular therapy is a promising strategy for treating refractory or relapsed hematological malignancies. Particularly, CAR-T cells have shown clinical efficacy in clinical trials, and different products are now commercially approved by regulatory agencies in the USA and Europe. Many challenges still need to be solved to improve and optimize the potential of these therapies worldwide. Global access to cell therapy is a significant concern, and different strategies are being explored in the middle- and low-income countries. In Mexico, leukemias represent around 50% of total cancer diagnosed in pediatric patients, and the rate of relapsed or refractory disease is higher than reported in other countries, a multi-factorial problem. Although significant progress has been made during the last decades in leukemia diagnosis and treatment, making new therapies available to Mexican patients is a priority, and cell and gene therapies are on the horizon. Efforts are ongoing to make CAR-T cell therapy accessible for patients in Mexico. This article summarizes a general landscape of childhood leukemias in Mexico, and we give a perspective about the current strategies, advances, and challenges ahead to make gene and cell therapies for leukemia clinically available.

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Association of Outcomes and Socioeconomic Status in Mexican Patients Undergoing Allogeneic Stem Cell Transplantation

Cited by 3 publications

References 17 publications

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country

Infections after hematopoietic cell transplantation are not a burden for mortality at a limited‐resource center in a developing country

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

Childhood leukemias in Mexico: towards implementing CAR-T cell therapy programs

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