Human development index linked to stem cell transplant rates and success in leukemia patients

April 15, 2010

The socioeconomic status of a country has long been considered a potentially significant factor in the availability of high-quality health-care interventions and even a determinant of long-term patient outcomes. A new study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation reports that in Europe, socioeconomic factors have a direct correlation to the rates and outcomes of stem cell transplantation for patients with acute myeloid leukemia (AML).

This study was published online today in Blood, the official journal of the American Society of Hematology.

"Stem cell transplantation is an expensive procedure requiring well-equipped transplant units; advanced, long-term supportive care; and highly qualified medical and nursing staff, so it may be expected that access to these transplants as well as outcome of the procedure would depend on socioeconomic factors varying among and within countries," said lead study author Sebastian Giebel, MD, of the Department of Clinical and Experimental Oncology at the Comprehensive Cancer Center of the Maria Sklowdowska-Curie Memorial Institute in Gliwice, Poland.

In this study, a team of researchers led by Dr. Giebel evaluated the association of the Human Development Index (HDI) with rates and outcomes (both short- and long-term) of AML patients treated with hematopoietic (HSCT). Using data on 16,403 patients from 30 European countries between 2001-2005, the team compared socioeconomic status with HSCT procedure rates. They then analyzed long-term outcomes (primarily leukemia-free survival, or LFS) related to HSCT for a sub-group of 2,015 AML patients who had received an HLA-matched allogeneic (using donor cells rather than one's own cells) HSCT.

The HDI is used by the United Nations to measure the of countries across three basic categories: longevity (expressed as a life expectancy index, or LEI), knowledge (expressed as education index, or EI) and standard of living (measured by gross domestic product index, or GDPI). Based on the HDI, countries are considered to have a low, intermediate, or high development status. Most European states fall into the "high" category, but there are some variations so, for the purpose of this study, countries were categorized into five distinct HDI ranges.

Results of the study found that in Europe, the HDI was associated with both rates and results of HSCT for acute leukemia, with the strongest association related to the few countries in the highest HDI group (eight countries). With regard to rates of HSCT procedures, the team found significant correlations between HDI and total HSCTs performed for AML patients. The strongest associations were found between transplant rates and scores related specifically to LEI and GDPI, suggesting that not only purely economic conditions, but also the organization of the health-care and educational systems likely translate into availability of HSCT.

With regard to patient outcomes, transplants performed in countries in the highest HDI group were associated with significantly higher LFS (68%), which resulted mainly from reduced risk of relapse, as compared with the other four HDI groups (56%, 59%, 63%, and 58%, respectively, in order of increasing HDI score).

"We believe there is still room for improvement in most European states to reach the outcomes achieved by the highest-HDI states, and identifying the factors that contribute to these differences is critical," said Dr. Giebel. "Our study was retrospective in nature, so we would encourage further prospective studies with detailed patient and procedural characteristics to help understand the true differences and design interventions to improve outcomes worldwide."

Previous studies have demonstrated some association of socioeconomic status (SES) with access to HSCT and mortality after transplantation in other parts of the world, but the association had not previously been studied across Europe, where diversity of SES may be less pronounced and most countries are considered well-developed. However, differences remain with regard to standard of living, education, and organization of health care, which may be reflected in the variations in HDI. Variable factors suggested by the study authors may include compliance with chemotherapy protocol, health insurance coverage, educational status, and availability of care.

Explore further: Long-term cancer risk follows stem cell transplant recipients

Related Stories

Long-term cancer risk follows stem cell transplant recipients

November 27, 2006

Hematopoietic stem cell transplant (HSCT) recipients face a significant long-term risk for developing a second cancer, particularly if they were older at the time of transplant or received stem cells from a female donor, ...

Research shows cord blood comparable to matched bone marrow

June 8, 2007

University of Minnesota researchers report that umbilical cord blood transplants may offer blood cancer patients better outcomes than bone marrow transplants, according to an analysis of outcome data performed at the Center ...

Recommended for you

How the finch changes its tune

August 3, 2015

Like top musicians, songbirds train from a young age to weed out errors and trim variability from their songs, ultimately becoming consistent and reliable performers. But as with human musicians, even the best are not machines. ...

Machine Translates Thoughts into Speech in Real Time

December 21, 2009

( -- By implanting an electrode into the brain of a person with locked-in syndrome, scientists have demonstrated how to wirelessly transmit neural signals to a speech synthesizer. The "thought-to-speech" process ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.