期刊
BLOOD
卷 137, 期 4, 页码 556-568出版社
AMER SOC HEMATOLOGY
DOI: 10.1182/blood.2020006252
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资金
- K07 award from the National Institutes of Health (NIH)/National Cancer Institute (NCI) [1K07CA211847]
- NIH/NCI Public Health Service [U24CA076518]
- NIH/National Heart, Lung and Blood Institute (NHLBI) [U24HL138660, OT3HL147741, R21HL140314, U01HL128568]
- NIH/Health Resources and Services Administration [HHSH250201700006C, SC1MC31881-01-00, HHSH250201700007C]
- Office of Naval Research [N00014-18-1-2850, N00014-18-1-2888, N00014-20-1-2705]
- NIH/NCI [P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141]
- NIH/NHLBI [R01HL126589, R01HL129472, R01HL130388, R01HL131731]
- NIH/National Institute of Allergy and Infectious Diseases [R01AI128775, U01AI069197, U01AI126612]
- Biomedical Advanced Research and Development Authority
- Be theMatch Foundation
- Boston Children's Hospital
- Dana-Farber
- Japan Hematopoietic Cell Transplantation Data Center
- St Baldrick's Foundation
- National Marrow Donor Program
- Medical College of Wisconsin
- AbbVie
- Actinium Pharmaceuticals, Inc
- Adaptive Biotechnologies
- Adienne SA
- Allovir, Inc
- Amgen, Inc
- Anthem, Inc
- Astellas Pharma US
- AstraZeneca
- Atara Biotherapeutics, Inc
- bluebird bio, Inc
- Bristol Myers Squibb Co
- Celgene Corp
- Chimerix, Inc
- CSL Behring
- CytoSen Therapeutics, Inc
- Daiichi Sankyo Co, Ltd
- GamidaCell, Ltd
- Genzyme
- GlaxoSmithKline
- HistoGenetics, Inc
- Incyte Corp
- Janssen Biotech, Inc
- Janssen Pharmaceuticals, Inc
- Janssen/Johnson Johnson
- Jazz Pharmaceuticals, Inc
- Kiadis Pharma
- Kite Pharma
- Kyowa Kirin
- Legend Biotech
- Magenta Therapeutics
- Mallinckrodt, LLC
- Medac GmbH
- Merck Company, Inc
- Merck Sharp Dohme Corp
- Mesoblast
- Takeda Oncology Co
- Miltenyi Biotec, Inc
- Novartis Oncology
- Novartis Pharmaceuticals Corp
- Omeros Corp
- Oncoimmune, Inc
- Orca Biosystems, Inc
- Pfizer, Inc
- Phamacyclics, LLC
- Regeneron Pharmaceuticals, Inc
- REGiMMUNE Corp
- Sanofi Genzyme
- Seattle Genetics
- Sobi, Inc
- Takeda Oncology
- Takeda Pharma
- Terumo BCT
- Viracor Eurofins
- Xenikos BV
- Millennium
This study aimed to investigate the impact of neighborhood poverty on outcomes of pediatric allogeneic HCT recipients, revealing that in malignant diseases, neighborhood poverty increased the risk of transplantation-related mortality but did not affect overall survival or other HCT outcomes; for nonmalignant diseases, neighborhood poverty had no association with HCT outcomes. Additionally, children with Medicaid insurance experienced worse overall survival and increased transplantation-related mortality in malignant diseases.
Social determinants of health, including poverty, contribute significantly to health outcomes in the United States; however, their impact on pediatric hematopoietic cell transplantation (HCT) outcomes is poorly understood. We aimed to identify the association between neighborhood poverty and HCT outcomes for pediatric allogeneic HCT recipients in the Center for International Blood and Marrow Transplant Research database. We assembled 2 pediatric cohorts undergoing first allogeneic HCT from 2006 to 2015 at age 518 years, including 2053 children with malignant disease and 1696 children with nonmalignant disease. Neighborhood poverty exposure was defined a priori per the US Census definition as living in a high-poverty ZIP code (>= 20% of persons below 100% federal poverty level) and used as the primary predictor in all analyses. Our primary outcome was overall survival (OS), defined as the time from HCT until death resulting from any cause. Secondary outcomes included relapse and transplantation-related mortality (TRM) in malignant disease, acute and chronic graft-versus-host disease, and infection in the first 100 days post-HCT. Among children undergoing transplantation for nonmalignant disease, neighborhood poverty was not associated with any HCT outcome. Among children undergoing transplantation for malignant disease, neighborhood poverty conferred an increased risk of TRM but was not associated with inferior OS or any other transplantation outcome. Among children with malignant disease, a key secondary finding was that children with Medicaid insurance experienced inferior OS and increased TRM compared with those with private insurance. These data suggest opportunities for future investigation of the effects of household-level poverty exposure on HCT outcomes in pediatric malignant disease to inform care delivery interventions.
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