Pre-transplant Dementia is Associated with Poor Survival After Hematopoietic Stem Cell Transplantation: A Nationwide Cohort Study with Propensity Score Matched Control

Abstract

Objective No previous study examined impact of dementia in the outcome of allogeneic hematopoietic stem cell transplantation (HSCT). We aimed to investigate overall survival (OS) of patients with dementia after receiving HSCT. Methods Among 8,230 patients who underwent HSCT between 2002 and 2018, 5,533 patients younger than 50 years were first excluded. Remaining patients were divided into those who were and were not diagnosed with dementia before HSCT (dementia group n = 31; no dementia n = 2,666). Thereafter, among 2,666 participants without dementia, 93 patients were selected via propensity-matched score as non-dementia group. Patients were followed from the day they received HSCT to the occurrence of death or the last follow-up day (December 31, 2018), whichever came first. Results With median follow-up of 621 days for dementia group and 654 days for non-dementia group, 2 year-OS of dementia group was lower than that of non-dementia group (53.3% [95% confidence interval, 95% CI, 59.0−80.2%] vs. 68.8% [95% CI, 38.0−68.2%], p = 0.076). In multivariate analysis, dementia had significant impacts on OS (hazard risk = 2.539, 95% CI, 1.166−4.771, p = 0.017). Conclusion Our results indicated that patients diagnosed with dementia before HSCT have 2.539 times higher risk of mortality after transplantation than those not having dementia. With number of elderly needing HSCT is increasing, further work to establish treatment guidelines for the management of HSCT in people with dementia is needed.

The Impact of COVID-19 on Psychiatric Health in the Korean Population

“…Ever since the Korean government created and opened the National Health Information Database, which consists of healthcare data including health screening results, sociodemographic variables, and mortality for the whole Korean population, a growing number of studies have used this database to conduct nationwide cohort studies [ 16 ]. The Korean government also further created the National Health Insurance Service (NHIS) COVID-19 database, which has aimed to promote COVID-19-related medical research in cooperation with the KDCA [ 17 ].…”

Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study

“…It carries a comprehensive set of databases comprising the health information of 50 million Koreans, including demographic variables such as age and sex, and medical treatment databases harboring universal medical claims and mortality data involving the whole Korean population 15 . Accordingly, KNHIS database has contributed to various epidemiological investigations into hematologic disease 16‐20 …”

“…15 Accordingly, KNHIS database has contributed to various epidemiological investigations into hematologic disease. [16][17][18][19][20] The study protocol is described in Figure 1. For patients in the primitive case and case cohorts, the index date was defined as the date of allo-SCT, whereas the index date was indicated as the year of participation in the public health checkup for individuals in the primitive control and control cohorts.…”