title: Association of Macroeconomic Factors With Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation for Adults With Acute Lymphoblastic Leukemia: An Analysis From the Acute Leukemia Working Party of the EBMT.
abstract: OBJECTIVE
  From a global perspective, the rates of allogeneic hematopoietic cell transplantation (alloHCT) are closely related to the economic status of a country. However, a potential association with outcome has not yet been documented. The goal of this study was to evaluate effects of health care expenditure (HCE), Human Development Index (HDI), team density, and center experience on nonrelapse mortality (NRM) after HLA-matched sibling alloHCT for adults with acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  A total of 983 patients treated with myeloablative alloHCT between 2004 and 2008 in 24 European countries were included.
  
  
  RESULTS
  In a univariate analysis, the probability of day 100 NRM was increased for countries with lower current HCE (8% vs. 3%; p = .06), countries with lower HDI (8% vs. 3%; p = .02), and centers with less experience (8% vs. 5%; p = .04). In addition, the overall NRM was increased for countries with lower current HCE (21% vs. 17%; p = .09) and HDI (21% vs. 16%; p = .03) and for centers with lower activity (21% vs. 16%; p = .07). In a multivariate analysis, the strongest predictive model for day 100 NRM included current HCE greater than the median (hazard ratio [HR], 0.39; p = .002). The overall NRM was mostly predicted by HDI greater than the median (HR, 0.65; p = .01). Both lower current HCE and HDI were associated with decreased probability of overall survival.
  
  
  CONCLUSIONS
  Both macroeconomic factors and the socioeconomic status of a country strongly influence NRM after alloHCT for adults with ALL. Our findings should be considered when clinical studies in the field of alloHCT are interpreted.
authors: Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland sgiebel@io.gliwice.pl.
authors: Sebastian
authors: S
authors: Giebel
authors: Hospital Saint-Antoine, Asistance Publique Hopitaux de Paris, Paris, France European Group for Blood and Marrow Transplantation, Acute Leukemia Working Party Office, Hospital Saint Antoine, Paris, France Universite Pierre et Marie Curie, Paris, France INSERM Unités Mixtes de Recherche 938, Paris, France.
authors: Myriam
authors: M
authors: Labopin
authors: Azienda Ospedaliera Universitaria San Martino Istituto di Ricovero e Cura a Carattere Scientifico, Genova, Italy.
authors: Adalberto
authors: A
authors: Ibatici
authors: St. James's Hospital, Dublin, Ireland.
authors: Paul
authors: P
authors: Browne
authors: Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
authors: Tomasz
authors: T
authors: Czerw
authors: Hopital St. Louis, Paris, France.
authors: Gerard
authors: G
authors: Socie
authors: Erciyes Medical School, Kapadokya Bone Marrow Transplanatation Center, Kayseri, Turkey.
authors: Ali
authors: A
authors: Unal
authors: Silesian Medical University, Katowice, Poland.
authors: Slawomira
authors: S
authors: Kyrcz-Krzemien
authors: Azienda Ospedaliera Universitaria San Martino Istituto di Ricovero e Cura a Carattere Scientifico, Genova, Italy.
authors: Andrea
authors: A
authors: Bacigalupo
authors: Hacettepe University, Ankara, Turkey.
authors: Hakan
authors: H
authors: Goker
authors: Trustee of London Clinic, London, United Kingdom.
authors: Mike
authors: M
authors: Potter
authors: Trustee of London Clinic, London, United Kingdom.
authors: Caroline L
authors: CL
authors: Furness
authors: Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
authors: Grant
authors: G
authors: McQuaker
authors: University Hospital, Essen, Germany.
authors: Dietrich
authors: D
authors: Beelen
authors: University Hospital and University of Bordeaux, Pessac, France.
authors: Noel
authors: N
authors: Milpied
authors: Instituto Portuguęs de Oncologia do Porto, Porto, Portugal.
authors: Antonio
authors: A
authors: Campos
authors: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors: Charles
authors: C
authors: Craddock
authors: European Group for Blood and Marrow Transplantation, Acute Leukemia Working Party Office, Hospital Saint Antoine, Paris, France Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors: Arnon
authors: A
authors: Nagler
authors: Hospital Saint-Antoine, Asistance Publique Hopitaux de Paris, Paris, France European Group for Blood and Marrow Transplantation, Acute Leukemia Working Party Office, Hospital Saint Antoine, Paris, France Universite Pierre et Marie Curie, Paris, France INSERM Unités Mixtes de Recherche 938, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease; D017048:Health Care Costs; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; Health care expenditure; Hematopoietic cell transplantation; Human development index; Non-relapse mortality