title: Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia.
abstract: Human Development Index (HDI) is used by the United Nations Organization to measure socioeconomic achievements of countries. We evaluated the association of HDI with rates and outcomes of hematopoietic stem cell transplantation (HSCT) for patients with acute leukemia. For the analysis of HSCT rates, all adults with acute leukemia (n = 16 403) treated in 30 European countries, between 2001 and 2005, were included. Association of HDI with the outcome was analyzed for 2015 patients with acute myeloid leukemia treated with myeloablative allotransplantation. Countries were classified according to HDI quintiles. Highly significant correlation was found for HDI and the total number of HSCT per population (R = 0.78; P < .001), as well as separately for sibling HSCT (R = 0.84; P < .001), unrelated HSCT (R = 0.66; P < .001), and autologous HSCT (R = 0.43; P = .02). The probabilities of leukemia-free survival for 5 consecutive groups of countries with increasing HDI were: 56%, 59%, 63%, 58%, and 68% (P = .01). In a multivariate analysis, transplantations performed in countries belonging to the upper HDI category were associated with higher leukemia-free survival compared with the remaining ones (HR = 1.36, P = .008), which resulted mainly from reduced risk of relapse (HR = 0.72, P = .04). We conclude that, in Europe, the HDI is associated with both rates and results of HSCT for acute leukemia.
authors.affiliation: Department of Clinical and Experimental Oncology, Division of Bone Marrow Transplantation and Lymphoma, Comprehensive Cancer Centre, Maria Sklodowska-Curie Memorial Institute-Gliwice Branch, WybrzezeArmii Krajowej 15, 1 Gliwice, Poland. sgiebel@poczta.onet.pl
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giebel
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czerw
authors.forename: Jerzy
authors.initials: J
authors.lastname: Holowiecki
authors.forename: Evandro M
authors.initials: EM
authors.lastname: Fagundes
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Nowara
authors.forename: Francesco
authors.initials: F
authors.lastname: Frassoni
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D004522:Educational Status; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000145:classification / Q000601:surgery*; D008136:Longevity; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014185:Transplantation, Isogeneic; D055815:Young Adult