title: Outcomes of hematologic malignancies after unrelated donor hematopoietic cell transplantation according to place of residence.
abstract: Studies suggest that patients who live in rural areas may have worse clinical outcomes compared with patients living in urban areas. We studied whether place of residence (rural versus urban) is associated with clinical outcomes of patients with leukemia or myelodysplastic syndrome (MDS) who received an unrelated donor hematopoietic cell transplantation (HCT). Patients' residential ZIP code at the time of transplant was used to determine rural or urban designation based on the Rural Urban Commuting Codes. The study included 6140 patients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 121 U.S. HCT centers: 1179 (19%) came from rural areas, whereas 4961 (81%) came from urban areas. Rural and urban patients were similar in patient-, disease-, and transplant-related characteristics aside from household income and distance traveled to the HCT center. After adjusting for income and other significant patient, disease, and transplant-related variables, the risk of overall mortality between patients residing in rural and urban areas were not statistically significant (relative risk 1.01, 95% confidence intervals 0.93-1.10, P = .74). Similar outcomes were noted for treatment-related mortality (TRM), disease-free survival (DFS), and relapse. Patient's income, derived from the U.S. Census and based on their residential ZIP code, was independently associated with outcomes. In summary, our study showed no differences in the clinical outcomes of patients from rural or urban areas after unrelated donor HCT.
authors.affiliation: Section of Hematology/Oncology, Department of Internal Medicine, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, USA. floberiza@unmc.edu
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Anna
authors.initials: A
authors.lastname: Hassebroek
authors.forename: Jason G
authors.initials: JG
authors.lastname: Dehn
authors.forename: Haydar A
authors.initials: HA
authors.lastname: Frangoul
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Charles F
authors.initials: CF
authors.lastname: LeMaistre
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006086:Graft vs Host Disease / Q000401:mortality; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D044469:Racial Groups / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States; D014504:Urban Health / Q000706:statistics & numerical data*; D055815:Young Adult