Regional Disparities and Socioeconomic Factors Affecting Outcomes of Hematopoietic Cell Transplantation in Brazil: Insights From the Brazilian Bone Marrow Transplant Map.
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Fatobene Giancarlo, Vergueiro Carmen, Simione Anderson João, Mariano Lívia, Colturato Vergílio, Filho José Ulysses Amigo, Calixto Rodolfo Froes, Feliciano João Vitor Piccolo, Filho Jayr Schmidt, Vigorito Afonso Celso, Lerner Décio, Araújo Renato de Castro, Arrais Celso, Moreira Maria Claudia Rodrigues, Novis Yana, Astigarraga Claudia Caceres, Soares Rodolfo Daniel de A, Barros George Maurício Navarro, Teixeira Gustavo Machado, Zanão Vivian Aparecida, de Azevedo Wellington Morais, Rodrigues Ana Luiza Melo, Daudt Liane Esteves, da Silva Roberto Luiz, Folloni Juliana Fernandes, Santucci Rodrigo, Nunes Elenaide C, Muzzi Guilherme Campos, Schaffel Rony, Macedo Maria Cristina Martins de Almeida, Rocha Vanderson, Seber Adriana
Аннотация
OBJECTIVE: This study analyzes BMTM data to characterize regional disparities, socioeconomic factors, and patient outcomes.
STUDY DESIGN: We retrospectively analyzed data from 31 transplant centers, including autologous and allogeneic HCTs performed between 2019 and 2023. We evaluated the impact of patient- and state-level clinical and socioeconomic factors on progression-free survival (PFS) and overall survival (OS).
RESULTS: A total of 5074 HCTs (2695 allogeneic and 2379 autologous) were included, primarily male and from the Southeast region, where most transplants were performed. Nearly one in 5 patients had to relocate to another region for treatment. In the public setting, auto-HCT recipients treated outside their home region were more highly educated. One-year PFS and OS for adult allo-HCT recipients with acute leukemia (AL) were 62% and 65%, respectively, and 71% and 79% in children. In unadjusted analyses of adults with AL undergoing allo-HCT or MM receiving auto-HCT, a Karnofsky performance score <80 was associated with worse survival. Adults with MM undergoing auto-HCT at private centers had superior PFS compared with those treated at public centers. State-level socioeconomic factors also significantly impacted survival. One-year nonrelapse mortality after allo-HCT was 25% in adults and 14% in children. Infection was the leading cause of death in adult allo-HCT recipients, both before and after d +100, and until d +100 in children.
CONCLUSIONS: Reducing patient migration and improving transplant access requires greater regionalization of HCT care. Lowering infection-related mortality represents an unmet need. These findings warrant further validation in future studies.