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Lymphoma

Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma

Bone Marrow Transplantation volume 51, pages 1191–1196 (2016)Cite this article

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Abstract

Socioeconomic status (SES) is an important determinant of disparities in health care. The association of SES with outcomes in autologous hematopoietic cell transplantation (AHCT) has not been described previously. We conducted a retrospective cohort study of 687 AHCT recipients with lymphoma transplanted between 2003 and 2013. Patients were categorized into low (<$50 000/year) and high SES (⩾$50 000/year). A greater proportion of low SES patients lived farther away from our center (median 54 vs 28 miles), belonged to a racial minority (12 vs 3%), had poorer performance status (4 vs 1%) and had high-risk disease at AHCT (9 vs 5%). Median follow-up was 53 months. In univariable analysis, low SES patients had significantly higher relapse mortality and lower OS and PFS. This was confirmed on multivariable analysis for relapse mortality (HR for high vs low SES: 0.74 (95% confidence interval (CI), 0.54–0.99), P=0.05), OS (HR 0.74 (0.58–0.95), P=0.02) and PFS (HR 0.77 (0.63–0.95), P=0.02). In multivariable analysis of ⩾1-year progression-free survivors, high SES patients had better OS (HR 0.73, P=0.05 vs low SES) that was primarily driven by a trend toward lower risk of non-relapse mortality (HR 0.62, P=0.06). SES is associated with outcomes of AHCT in patients with lymphoma.

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Acknowledgements

This study was partly supported by American Society of Hematology HONORS (Hematology Opportunities for the Next Generation of Research Scientists) Award to Sanghee Hong.

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Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    S Hong

  2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    L Rybicki

  3. Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    D M Abounader, B J Bolwell, R Dean, A T Gerds, B K Hamilton, B T Hill, D Jagadeesh, M Kalaycio, H D Liu, B Pohlman, R Sobecks & N S Majhail

  4. Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA

    B J Bolwell, R Dean, A T Gerds, B K Hamilton, B T Hill, D Jagadeesh, M Kalaycio, H D Liu, B Pohlman, R Sobecks & N S Majhail

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Correspondence to N S Majhail.

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Hong, S., Rybicki, L., Abounader, D. et al. Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma. Bone Marrow Transplant 51, 1191–1196 (2016). https://doi.org/10.1038/bmt.2016.107

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