title: Association of Socioeconomic Status with Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma.
abstract: Autologous hematopoietic cell transplantation (AHCT) is standard therapy for eligible patients with multiple myeloma. Health care disparities can influence transplantation outcomes. However, the association of socioeconomic status (SES), a major indicator of health care disparities, with outcomes in patients with myeloma after AHCT has not been previously described. We analyzed 346 consecutive AHCT recipients with myeloma who underwent transplantation between 2003 and 2013 in this retrospective cohort study. Zip code of residence at the time of AHCT was obtained to assess annual household income based on 2010 US census data (median, $49,054; range, $16,546 to $127,313). SES groups were divided into < $45,000 (low; n = 120), $45,000 to $60,000 (middle; n = 116), and > $60,000 (high; n = 110). The low-income cohort had smallest portion of Caucasians (69% versus 89% versus 91%); otherwise, patient, disease, and transplantation characteristics were comparable among cohorts or different without significant patterns found. Median follow-up was 49 months. There was no difference among SES groups in overall survival, progression-free survival, nonrelapse mortality, or relapse in univariate and multivariable analysis. Similarly, SES was not associated with survival in a subset analysis of 303 patients who had survived for 1 year after transplantation.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sanghee
authors.initials: S
authors.lastname: Hong
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Donna
authors.initials: D
authors.lastname: Abounader
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Gerds
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Betty K
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Hill
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Deepa
authors.initials: D
authors.lastname: Jagadeesh
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hien D
authors.initials: HD
authors.lastname: Liu
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.affiliation: Blood and Marrow Transplantation Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio. Electronic address: majhain@ccf.org.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000191:economics / Q000208:ethnology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000208:ethnology / Q000401:mortality / Q000592:standards*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012923:Social Class; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Autologous stem cell transplantation; Ethnicity; Health care disparities; Income; Multiple myeloma; Socioeconomic status