Long-term outcomes for leukemia patients linked to socioeconomic factors
Sebastian Giebel, MD, of the Department of Clinical and Experimental Oncology at the Comprehensive Cancer Center of the Maria Sklowdowska-Curie Memorial Institute, and colleagues conducted a study to evaluate the association between the Human Development Index (HDI) and the rates and outcomes of patients with acute myeloid leukemia (AML). Involved in the study were 16,406 patients with AML who were treated with hematopoietic stem cell transplantation (HSCT). Researcher compared socioeconomic status with HSCT procedure rates and then analyzed long-term outcomes related to HSCT for a subgroup of 2,015 AML patients who had received an HLA-matched allogeneic HSCT.
The findings revealed that in Europe, the HDI was linked to both rates and results of HSCT for acute leukemia, with the strongest association related to the few countries in the highest HDI group. Researchers reported significant correlations between HDI and total HSCTs performed for AML patients.
Most significant in the study's findings was that the strongest associations were observed between transplant rates and scores related specifically to life expectancy and gross domestic product. Researchers suggested that not only purely economic conditions but also the organization of the health care and educational systems likely translate into availability of HSCT.
Results for patient outcomes revealed that transplants performed in countries in the highest HDI group were associated with significantly higher leukemia-free survival (68%), which resulted mainly from reduced risk of relapse, as compared with the other four HDI groups (56%, 59%, 63%, and 58%, respectively, in order of increasing HDI score)
"We believe there is still room for improvement in most European states to reach the outcomes achieved by the highest-HDI states, and identifying the factors that contribute to these differences is critical," said Dr. Giebel. "Our study was retrospective in nature, so we would encourage further prospective studies with detailed patient and procedural characteristics to help understand the true differences and design interventions to improve outcomes worldwide."
The study's findings were published in Blood (2010 Apr 15 [Epub ahead of print]).