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Social Study

Patient socioeconomic status as a prognostic factor for allo-SCT

Bone Marrow Transplantation volume 43, pages 571–577 (2009)Cite this article

Abstract

The aim of the present study was to assess the influence of socioeconomic status (SeS) on the outcome of allo-SCT at a Brazilian SCT center. In total, 201 patients receiving HLA-identical related allo-SCTs were studied. The median age was 30 years. Overall, 163 patients had malignancies (CML 68, ALL/AML 63, myelodysplastic syndrome 12 and others 20). SeS was defined according to the Brazilian Association of Market Research Agencies classification, where people are clustered in groups A–E (richest to poorest). In total, 146 patients (72%) were classified as richest (A+B+C) and 55 (28%) as poorest (D+E). The D+E SeS group was associated with a higher incidence of chronic GVHD and acute GVHD (hazard ratio (HR)=2.61; P=0.001 and HR=2.62; P=0.001, respectively), better platelet and neutrophil engraftment (HR=1.94; P=<0.001 and HR=2.12; P=0.001) and with a higher TRM in multivariate analysis (HR=1.92; P=0.039). Estimated overall survival at 5 years was 55.2%. A D+E SeS (HR=2.13; P=0.001) was associated with a worse survival on multivariate analysis. In conclusion, a lower SeS is a strong prognostic factor in patients undergoing allo-SCT in Brazil, influencing engraftment, TRM and overall survival.

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References

  1. Schmitz N, Gratwohl A, Goldman JM . Allogeneic and autologous transplantation for haematological diseases, solid tumors and immune disorders. Current practice in Europe in 1996 and proposals for an operational classification. Accreditation Sub-Committee of the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 1996; 17: 471–477.

    CAS  PubMed  Google Scholar 

  2. Nash R, Pepe M, Storb R, Longton G, Pettinger M, Anasetti C et al. Acute graft-versus-host disease: analysis of risk factors after allogeneic marrow transplantation and prophylaxis with cyclosporine and methotrexate. Blood 1992; 80: 1838–1845.

    CAS  PubMed  Google Scholar 

  3. Winston D, Gale R, Meyer D, Young L . Infectious complications of human bone marrow transplantation. Medicine (Baltimore) 1979; 58: 1–31.

    Article  CAS  Google Scholar 

  4. Bittencourt H, Rocha V, Chevret S, Socié G, Espérou H, Devergie A et al. Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation. Blood 2002; 99: 2726–2733.

    Article  CAS  PubMed  Google Scholar 

  5. Blakely T, Atkinson J, Kiro C, Blaiklock A, D’Souza A . Child mortality, socioeconomic position, and one-parent families: independent association and variation by age and cause of death. Int J Epidemiol 2003; 32: 410–418.

    Article  PubMed  Google Scholar 

  6. Rutledge T, Reis SE, Olson M, Owens J, Kelsey SF, Pepine CJ et al. Socioeconomic status variables predict cardiovascular disease risk factors and prospective mortality risk among women with chest pain. The WISE study. Behav Modif 2003; 27: 54–67.

    Article  PubMed  Google Scholar 

  7. Bassanesi S, Azambuja MI, Achutti A . Premature mortality due to cardiovascular disease and social inequalities in Porto Alegre: from evidence to action. Arq Bras Cardiol 2008; 90: 403–412.

    Article  Google Scholar 

  8. Cesaroni G, Farchi S, Davoli M, Forastiere F, Perucci CA . Individual and area-based indicators of socioeconomic status in childhood asthma. Eur Respir J 2003; 22: 619–624.

    Article  CAS  PubMed  Google Scholar 

  9. Kapral M, Wang H, Mamdani M . Effect of socioeconomic status on treatment and mortality after stroke. Stroke 2002; 33: 274–275.

    Article  Google Scholar 

  10. Cross C, Harris J, Recht A . Race, socioeconomic status and breast carcinoma in the US: what have we learned from clinical studies. Cancer 2002; 95: 1988–1999.

    Article  PubMed  Google Scholar 

  11. Wrigley H, Roderick P, George S, Smith J, Mullee M, Goddard J . Inequalities in survival from colorectal cancer: a comparison of the impact of deprivation, treatment, and host factors on observed and cause specific survival. J Epidemiol Community Health 2003; 57: 301–309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Hole D, McArdle C . Impact of socioeconomic deprivation on outcome after surgery for colorectal cancer. Br J Surgery 2002; 89: 586–590.

    Article  CAS  Google Scholar 

  13. Butkus D, Dottes A, Meydrech EF, Barber WH . Effect of poverty and other socio-economic variables on renal allograft survival. Transplantation 2001; 72: 261–266.

    Article  CAS  PubMed  Google Scholar 

  14. Savage D, Lindenbaum J, Ryzin J, Struening E, Garret T . Race, poverty, and survival in multiple myeloma. Cancer 1984; 54: 3085–3094.

    Article  CAS  PubMed  Google Scholar 

  15. Viana MB, Murao M, Ramos G, Oliveira HM, Carvalho RI, Bastos M et al. Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis. Arch Dis Child 1994; 71: 304–310.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Viana MB, Fernandes RAF, Oliveira BMA, Murao M, Paes CA, Duarte AA . Nutritional and socio-economic status in the prognosis of childhood acute lymphoblastic leukemia. Haematologica 2001; 86: 113–120.

    CAS  PubMed  Google Scholar 

  17. Baker KS, Loberiza Jr FR, Yu H, Cairo MS, Bolwell BJ, Bujan-Boza WA et al. Outcome of ethnic minorities with acute or chronic leukemia treated with hematopoietic stem-cell transplantation in the United States. J Clin Oncol 2005; 23: 7032–7042.

    Article  PubMed  Google Scholar 

  18. Karanth M, Begum G, Cook M, Lawson S, Porter C, Lister N et al. Increased acute GvHD and higher transplant-related mortality in non-Caucasians undergoing standard sibling allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 37: 419–423.

    Article  CAS  PubMed  Google Scholar 

  19. Daudt LE, Zechmaister D, Portal L, Neto EC, Silla LM, Giuliani R . Neonatal screening for hemoglobinopathies: a pilot study in Porto Alegre, Rio Grande do Sul, Brazil. Cad Saude Publica 2002; 18: 833–841.

    Article  PubMed  Google Scholar 

  20. http://www.ibge.gov.br/home/estatistica/populacao/contagem2007/popmunic2007layoutTCU14112007.xls-visited in June 2008.

  21. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  22. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  23. Alexanian R, Balcerzak S, Bonnet JD, Gehan EA, Haut A, Hewlett JS et al. Prognostic factors in multiple myeloma. Cancer 1975; 36: 1192–1201.

    Article  CAS  PubMed  Google Scholar 

  24. Hu E, Hufford S Lukes R, Berstein-Singer M, Sobel G, Gill P, Pinter-Brown L et al. Third-world Hodgkin's disease at Los Angeles County––University of Southern California Medical Center. J Clin Oncol 1998; 6: 1285–1292.

    Article  Google Scholar 

  25. Loureiro MM, Morais JC, Milito CB, Portugal RD, Pulcher W, Spector N . Expression of Epstein–Barr vírus in patients with Hodgkin's disease: report of 64 cases from Rio de Janeiro, Brazil. J Bras Patol Méd Lab 2004; 40: 37–40.

    Google Scholar 

  26. Spector N, Costa MA, Pulcheri W, Salgado RC, Nucci M, Andrade CA et al. C-MOPP/ABV yields good results in a public hospital population with Hodgkin's disease in Brazil. Cancer 1993; 71: 2823–2827.

    Article  CAS  PubMed  Google Scholar 

  27. Eid KAB, Miranda ECM, Vigorito AC, Aranha FJP, Oliveira GB, De Souza CA . The availability of full match sibling donors and feasibility of allogeneic bone marrow transplantation in Brazil. Braz J Med Biol Res 2003; 36: 315–321.

    Article  CAS  PubMed  Google Scholar 

  28. Horowitz MM, Rowlings PA . An update from the International Bone Marrow Transplantation Registry and the autologous blood and marrow transplant registry on current activity in hematopoietic stem cell transplantation. Curr Opin Hematol 1997; 4: 395–400.

    Article  CAS  PubMed  Google Scholar 

  29. Loberiza Jr FR, Zhang M-J, Lee SJ, Klein JP, LeMaistre CF, Serna DS et al. Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States. Blood 2005; 105: 2979–2987.

    Article  CAS  PubMed  Google Scholar 

  30. Lisot CL, Silla LM . Screening for hemoglobinopathies in blood donors from Caxias do Sul, Brazil: prevalence in an Italian colony. Cad Saude Publica 2004; 20: 1595–1601.

    Article  PubMed  Google Scholar 

  31. Sommer CK, Goldberck AS, Wagner SC, Castro SM . Neonatal screening for hemoglobinopathies: a one year experience in the public health system in Rio Grande do Sul, Brazil. Cad Saude Publica 2006; 22: 1709–1714.

    Article  PubMed  Google Scholar 

  32. http://pt.wikipedia.org/wiki/Rio_Grande_do_Sul-visited in June 2008.

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Authors and Affiliations

  1. Division of Hematology and Bone Marrow Transplantation, Department of Internal Medicine, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

    L Silla, G B Fischer, A Paz, L E Daudt, I Mitto, B Katz, M da Graça Grossini, H N Bittencourt, A Jochims, L Fogliatto, C M Bittar, J R Friedrisch & R I Bittencourt

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  1. L Silla
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  2. G B Fischer
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Correspondence to L Silla.

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Silla, L., Fischer, G., Paz, A. et al. Patient socioeconomic status as a prognostic factor for allo-SCT. Bone Marrow Transplant 43, 571–577 (2009). https://doi.org/10.1038/bmt.2008.358

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