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Olivieri DJ, Othus M, Orvain C, Rodríguez-Arbolí E, Milano F, Sandmaier BM, Khan I, Davis C, Basom RS, Appelbaum FR, Walter RB. Impact of socioeconomic disparities on outcomes in adults undergoing allogeneic hematopoietic cell transplantation for acute myeloid leukemia. Leukemia 2024; 38:865-876. [PMID: 38388647 PMCID: PMC10997459 DOI: 10.1038/s41375-024-02172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
Racial and socioeconomic disparities impact outcomes after chemotherapy and limit access to allogeneic hematopoietic cell transplantation (HCT) in acute myeloid leukemia (AML), yet studies have yielded mixed results on the influence of disparities on post-HCT outcomes. Therefore, we studied 1024 adults with AML who underwent allogeneic HCT between 5/2006 and 10/2021 at a single large university-affiliated cancer center. Collected data included non-biologic and demographic characteristics (including race/ethnicity, marital status, distance traveled, and household size), transplant- and disease-related characteristics, and area-level and individual-level socioeconomic factors (i.e., area deprivation index and occupational status). After multivariable adjustment, no socioeconomic- or non-biologic factors were associated with non-relapse mortality (NRM), overall survival (OS), relapse-free survival (RFS), or relapse except being married (associated with improved NRM: hazard ratio [HR] = 0.7 [0.50-0.97]) and having no insurance (associated with worse OS: HR = 1.49 [1.05-2.12] and RFS: HR = 1.41 [1.00-1.98]). Despite a relatively racially homogenous cohort, Asian race was associated with improved NRM (HR = 0.47 [0.23-0.93]) and American Indian/Alaskan Native race was associated with higher relapse risk (HR = 2.45 [1.08-5.53]). In conclusion, in our retrospective analysis, socioeconomic-, demographic-, and non-biologic factors had limited impact on post-HCT outcomes in AML patients allografted in morphologic remission. Further research is needed to investigate disparities among HCT-eligible patients.
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Affiliation(s)
- Daniel J Olivieri
- Department of Medicine, Internal Medicine Residency Program, University of Washington, Seattle, WA, USA
| | - Megan Othus
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Corentin Orvain
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Maladies du Sang, CHU d'Angers, Angers, France
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Angers, France
| | - Eduardo Rodríguez-Arbolí
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University of Seville, Seville, Spain
| | - Filippo Milano
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
| | - Brenda M Sandmaier
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
| | - Irum Khan
- Department of Medicine, Division of Hematology-Oncology, Northwestern University, Chicago, IL, USA
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ryan S Basom
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Frederick R Appelbaum
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roland B Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Medicine, Division of Hematology and Oncology, University of Washington, Seattle, WA, USA.
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
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Avila J, DuMontier C, Cernik C, Uno H, Hshieh T, Ho K, Mozessohn L, Driver JA, Abel GA. Marital status, frailty, and survival in older adults with blood cancer. J Geriatr Oncol 2023; 14:101589. [PMID: 37453810 PMCID: PMC11473264 DOI: 10.1016/j.jgo.2023.101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Jorge Avila
- Department of Medicine, St Elizabeth's Medical Center, Boston, MA, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Clark DuMontier
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Colin Cernik
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hajime Uno
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tammy Hshieh
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kristi Ho
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lee Mozessohn
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, USA
| | - Jane A Driver
- New England Geriatrics Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gregory A Abel
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Yi M, Li A, Zhou L, Chu Q, Song Y, Wu K. The global burden and attributable risk factor analysis of acute myeloid leukemia in 195 countries and territories from 1990 to 2017: estimates based on the global burden of disease study 2017. J Hematol Oncol 2020; 13:72. [PMID: 32513227 PMCID: PMC7282046 DOI: 10.1186/s13045-020-00908-z] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a common leukemia subtype and has a poor prognosis. The risk of AML is highly related to age. In the context of population aging, a comprehensive report presenting epidemiological trends of AML is evaluable for policy-marker to allocate healthy resources. METHODS This study was based on the Global Burden of Disease 2017 database. We analyzed the change trends of incidence rate, death rate, and disability-adjusted life year (DALY) rate by calculating the corresponding estimated annual percentage change (EAPC) values. Besides, we investigated the influence of social development degree on AML's epidemiological trends and potential risk factors for AML-related mortality. RESULTS From 1990 to 2017, the incidence of AML gradually increased in the globe. Males and elder people had a higher possibility to develop AML. Developed countries tended to have higher age-standardized incidence rate and death rate than developing regions. Smoking, high body mass index, occupational exposure to benzene, and formaldehyde were the main risk factors for AML-related mortality. Notably, the contribution ratio of exposure to carcinogens was significantly increased in the low social-demographic index (SDI) region than in the high SDI region. CONCLUSION Generally, the burden of AML became heavier during the past 28 years which might need more health resources to resolve this population aging-associated problem. In the present stage, developed countries with high SDI had the most AML incidences and deaths. At the same time, developing countries with middle- or low-middle SDI also need to take actions to relieve rapidly increased AML burden.
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Affiliation(s)
- Ming Yi
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Anping Li
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Linghui Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongping Song
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Kongming Wu
- Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
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Shallis RM, Wang R, Davidoff A, Ma X, Zeidan AM. Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges. Blood Rev 2019; 36:70-87. [PMID: 31101526 DOI: 10.1016/j.blre.2019.04.005] [Citation(s) in RCA: 428] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/06/2019] [Accepted: 04/26/2019] [Indexed: 01/08/2023]
Abstract
Acute myeloid leukemia (AML) is a malignant disorder of the bone marrow which is characterized by the clonal expansion and differentiation arrest of myeloid progenitor cells. The age-adjusted incidence of AML is 4.3 per 100,000 annually in the United States (US). Incidence increases with age with a median age at diagnosis of 68 years in the US. The etiology of AML is heterogeneous. In some patients, prior exposure to therapeutic, occupational or environmental DNA-damaging agents is implicated, but most cases of AML remain without a clear etiology. AML is the most common form of acute leukemia in adults and has the shortest survival (5-year survival = 24%). Curative therapies, including intensive chemotherapy and allogeneic stem cell transplantation, are generally applicable to a minority of patients who are younger and fit, while most older individuals exhibit poor prognosis and survival. Differences in patient outcomes are influenced by disease characteristics, access to care including active therapies and supportive care, and other factors. After many years without therapeutic advances, several new therapies have been approved and are expected to impact patient outcomes, especially for older patients and those with refractory disease.
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Affiliation(s)
- Rory M Shallis
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, USA; Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, USA
| | - Amy Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, USA; Department of Health Policy and Management, School of Public Health, Yale University, New Haven, USA
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, USA; Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, USA
| | - Amer M Zeidan
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, USA; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, USA.
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Chen M, Wang X, Wei R, Wang Z. The influence of marital status on the survival of patients with operable gastrointestinal stromal tumor: A SEER-based study. Int J Health Plann Manage 2018; 34:e447-e463. [PMID: 30272828 DOI: 10.1002/hpm.2661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Marital status has been demonstrated as a predictive factor for prognosis in diverse malignancies, but its role in the survival of gastrointestinal stromal tumor (GIST) remains unclear. MATERIAL AND METHODS This study was aimed to investigate the impact of marital status on the overall survival (OS) and cancer-specific survival (CSS) of operable GIST cases, by using data from Surveillance, Epidemiology, and End Results (SEER) database. In total, 6582 GIST patients between 1973 and 2013 were identified from SEER database. RESULTS Univariate and multivariate analyses demonstrated the marital status as an independent predictive factor for survival. Married group had better 5-year OS and CSS than unmarried group (OS: 79.2% vs 71.3%, P < .001; CSS: 88.9% vs 84.8%, P < .001). And compared to married, divorced/separated, and single group, widowed group had the lowest 5-year OS and CSS (61.3% and 82.2%). Further subgroup analyses validated the relationship between marital status and survival among all SEER stages and different age groups. And additional sensitivity analyses according to other clinicopathological features confirmed that married cases had higher survival rate than unmarried cases. CONCLUSION In conclusion, marriage could be a protective prognostic factor for survival, and widowed patients had a higher risk of death.
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Affiliation(s)
- Mo Chen
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Xuan Wang
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Ran Wei
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Zheng Wang
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
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Sato T, Konuma T, Oiwa-Monna M, Tanoue S, Isobe M, Jimbo K, Kasuya F, Hisahara M, Kobayashi K, Kato S, Takahashi S, Tojo A. Does marital status affect the outcomes after allogeneic hematopoietic cell transplantation? Bone Marrow Transplant 2018; 53:774-779. [DOI: 10.1038/s41409-018-0217-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/09/2022]
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