Abstract
Receipt of hematopoietic cell transplantation (HCT) can improve overall survival in older patients with intermediate or high-risk acute myeloid leukemia (AML); however, utilization of HCT is poor. It is important to understand the factors that affect the receipt of HCT in a real-world setting among the older patients. We utilized the National Cancer Database to determine receipt of HCT in older patients (61ā75 years) with intermediate or high-risk AML reported between 2003 and 2012. Multivariate logistic regression analysis was used to determine factors associated with receipt of HCT. Only 5.5% of older patients (nā=ā17,555) underwent HCT. Factors associated with a lower likelihood of receiving HCT included receipt of care in a non-academic hospital, race other than white, older age, Charlson comorbidity score of ā„1, uninsured status, Medicaid or Medicare insurance, and lower educational status. The receipt of HCT in older patients is low and varies based on biological as well as non-biologic factors, such as hospital type, insurance, and educational status. Nationwide efforts to improve access to HCT for appropriate patients are necessary.
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Acknowledgements
V.R.B. is supported by 2016ā2017 Physician-Scientist Training Program Grant from the College of Medicine, University of Nebraska Medical Center. The data used in the study are derived from a de-identified National Cancer Data Base file. The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoCās NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Authors contributions
V.R.B. and S.J.L. developed the concept and design of the study. V.R.B. and B.C. were involved with data analysis. All authors contributed to the interpretation of the results. The initial manuscript was drafted by V.R.B. and B.G. All authors reviewed and critically revised the manuscript. All the authors approved the final version of the manuscript.
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Bhatt, V.R., Chen, B., Gyawali, B. et al. Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia. Bone Marrow Transplant 53, 1288ā1294 (2018). https://doi.org/10.1038/s41409-018-0164-y
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DOI: https://doi.org/10.1038/s41409-018-0164-y
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