Does Outcomes of HSCT Differ According to Patients’ Socioeconomic Status? Real-World Data from an Outpatient-Based Center in Mexico

Abstract

Introduction The relationship between socioeconomic status (SES) and HSCT outcomes has not been well described in developing countries. Our center has established an outpatient-based HSCT program to reduce costs and improve its access to patients with different socioeconomic backgrounds. Nevertheless, post-HSCT follow-up implies an economic spending that many patients are unable to afford and may have a clinical impact. Objective We aimed to study the relationship between SES in transplant patients and clinical outcomes. Methods From August 2017 to May 2018, adult patients who received an HSCT and continued follow-up in our unit were recruited. They were enrolled into one of two cohorts: Cohort A included patients who received their first HSCT from January 2007 to July 2017, and Cohort B included those who were transplanted from August 2017 to May 2018. A validated questionnaire was applied to determine patients’ SES and demographic features. Clinical data were also obtained. Study endpoints included appearance of infections, mucositis, and hospitalizations by day 100. In patients with allo-HSCT, the cumulative incidence (CI) of acute GVHD (aGVHD) by day 100, and one-year CI of chronic GVHD (cGVHD) were assessed. In patients from Cohort B, one-year overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method. Results We included 83 patients: 50 in cohort A and 33 in cohort B. Thirty-seven patients received auto-HSCT (44.6%), 22 HLA-identical allo-HSCT (26.5%), and 24 HLA-haploidentical allo-HSCT (28.9%). Most common diagnosis were lymphoma, acute leukemia, and myeloma (30.1, 25.3 and 21.7%, respectively). Median follow-up was 9 months (1-107). Patients were divided into 3 groups according to SES. Excluding CMV status, there were no significant differences in pre-transplant features (Fig 1). We compared outcomes according to SES. We found more infectious episodes and hospitalization requirements by day 100 in patients with low-SES (70.8 and 62.5%, respectively), whereas incidence of mucositis was greater in patients with high-SES (58.3%); p>0.05. In patients receiving allo-HSCT, CI of aGVHD was higher in those with high-SES (33.3%), while patients with low-SES had a superior one-year CI of cGVHD; p>0.05 (Fig 2). One-year OS and DFS in patients from Cohort B were 93.5 and 74.1%, respectively. There was a trend to find a decreased one-year OS and DFS in subjects with low-SES compared to those with middle and high-SES (90 and 62.5% vs 94.1 and 77.8% vs 100 and 100%, respectively); p>0.05. Conclusion Outcomes after HSCT can be favorable even in low resource settings. There was a trend to find HSCT-related complications more frequently in patients with low-SES, including infections, cGVHD and reduced DFS. Special attention should be given to patients with limited socioeconomic conditions and adequate compliance must be emphasized to achieve satisfactory outcomes.