Association of socioeconomic status with autologous hematopoietic cell transplantation outcomes for lymphoma.
Socioeconomic status (SES) is an important determinant of disparities in health care. The association of SES with outcomes in autologous hematopoietic cell transplantation (AHCT) has not been described previously. We conducted a retrospective cohort study of 687 AHCT recipients with lymphoma transplanted between 2003 and 2013. Patients were categorized into low (<$50 000/year) and high SES (⩾$50 000/year). A greater proportion of low SES patients lived farther away from our center (median 54 vs 28 miles), belonged to a racial minority (12 vs 3%), had poorer performance status (4 vs 1%) and had high-risk disease at AHCT (9 vs 5%). Median follow-up was 53 months. In univariable analysis, low SES patients had significantly higher relapse mortality and lower OS and PFS. This was confirmed on multivariable analysis for relapse mortality (HR for high vs low SES: 0.74 (95% confidence interval (CI), 0.54-0.99), P=0.05), OS (HR 0.74 (0.58-0.95), P=0.02) and PFS (HR 0.77 (0.63-0.95), P=0.02). In multivariable analysis of ⩾1-year progression-free survivors, high SES patients had better OS (HR 0.73, P=0.05 vs low SES) that was primarily driven by a trend toward lower risk of non-relapse mortality (HR 0.62, P=0.06). SES is associated with outcomes of AHCT in patients with lymphoma.
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
S
S
Hong
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
L
L
Rybicki
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
D M
DM
Abounader
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
B J
BJ
Bolwell
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
R
R
Dean
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
A T
AT
Gerds
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
B K
BK
Hamilton
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
B T
BT
Hill
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
D
D
Jagadeesh
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
M
M
Kalaycio
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
H D
HD
Liu
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
B
B
Pohlman
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
R
R
Sobecks
Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
N S
NS
Majhail
D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult