title: Factors associated with hematopoietic cell transplantation (HCT) among patients in a population-based study of myelodysplastic syndrome (MDS) in Minnesota.
abstract: Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by dysplastic changes in the bone marrow, ineffective erythropoiesis, and an increased risk of developing acute myeloid leukemia. Treatment planning for patients with MDS is a complex process, and we sought to better characterize hematopoietic cell transplantation (HCT) outcomes and the factors that play into decision-making regarding referral of adults with MDS for definitive therapy with HCT. Patients enrolled in a population-based study of MDS between April 2010 and January 2013 who underwent HCT within the first year after enrollment were included in this analysis. Age- and risk-matched MDS patient controls also enrolled during that time period were used as a comparison. Survival was significantly better in the HCT group (48 vs. 21 %, log-rank p value 0.009). Non-HCT patients were more likely to have comorbidities, and HCT patients were more likely to have a college degree and an income >$80,000. All three of these variables were independently associated with HCT, but none impacted survival. Patients with MDS in our study who underwent HCT had better survival than a comparable group of patients who did not undergo HCT. With refined treatment techniques, more patients may be able to be considered for this therapy. More work needs to be done to determine why education and income appear to impact the decision to pursue HCT, but these factors may impact referral to an academic center where aggressive therapy like HCT is more likely to be considered.
authors.affiliation: Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, 420 Delaware Street SE; MMC 484, Minneapolis, MN, 55455, USA, smith719@umn.edu.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Smith
authors.forename: Erica D
authors.initials: ED
authors.lastname: Warlick
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Roesler
authors.forename: Jenny N
authors.initials: JN
authors.lastname: Poynter
authors.forename: Michaela
authors.initials: M
authors.lastname: Richardson
authors.forename: Phuong
authors.initials: P
authors.lastname: Nguyen
authors.forename: Adina
authors.initials: A
authors.lastname: Cioc
authors.forename: Betsy
authors.initials: B
authors.lastname: Hirsch
authors.forename: Julie A
authors.initials: JA
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011159:Population Surveillance; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome