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Impact of access to care on 1-year mortality following allogeneic blood or marrow transplantation

Bone Marrow Transplantation volume 56, pages 1364–1372 (2021)Cite this article

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Abstract

Mortality is highest in the first year following an allogeneic hematopoietic stem cell transplant. With recent advancements, we have expanded the pool of patients to whom we are able to offer transplant as a treatment option. In this context, we analyzed socioeconomic, patient, disease and transplant-related variables that predicted for 1-year all-cause, relapse-related (RRM) and non-relapse related mortality (NRM) in 304 patients at the University of Alabama at Birmingham. The 1-year overall survival, RRM and NRM rates were 60.5%, 13.5% and 22.7% respectively. A KPS score < 80, pre-transplant infection and hypertension and non-complete remission disease status adversely effected all-cause mortality. For NRM, increasing age, pre-transplant infection and diabetes, and poor access to care were associated with higher mortality whereas haploidentical donor type was associated with improved survival. For RRM, a KPS score <80, high/very high disease risk index and the presence of comorbidities were risk factors for higher mortality. Poor access to care, in addition to individual comorbidities, performance status and high-risk disease characteristics, is associated with adverse outcomes following transplant. We propose the incorporation of socioeconomic variables with patient, disease, and transplant-related variables to predict 1-year NRM.

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Fig. 1
Fig. 2: 1 year survival and all-cause mortality outcomes.
Fig. 3: 1 year relapse-related outcomes.
Fig. 4: 1 year non-relapse-related outcomes.

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Authors and Affiliations

  1. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Omer Jamy, Donna Salzman, Susan Bal, Antonio Di Stasi, Luciano Costa & Ravi Bhatia

  2. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA

    Alice Chen, Kevin Battles, Liton Francisco & Smita Bhatia

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  1. Omer Jamy
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Contributions

OJ, RB, and SB contributed toward the conception of the presented study. OJ, KB, and FL contributed toward data collection. OJ, AC, and SB contributed toward data analysis. OJ, DS, AD, SB, LC, RB, and SB contributed toward drafting, revising and approving the paper.

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Correspondence to Omer Jamy.

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Jamy, O., Chen, A., Battles, K. et al. Impact of access to care on 1-year mortality following allogeneic blood or marrow transplantation. Bone Marrow Transplant 56, 1364–1372 (2021). https://doi.org/10.1038/s41409-020-01184-8

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