Practice Patterns of Allogeneic Hematopoietic Cell Transplantation (HCT) for Adults with Acute Lymphoblastic Leukemia (ALL)

Abstract

Introduction:HCT is a valuable therapeutic modality in ALL. Though controversial in standard-risk ALL, particularly those who are treated with pediatric chemotherapy regimen, HCT is still considered to be the standard of care in high-risk patients such as Philadelphia chromosome positive ALL. Variations exist in the utilization of HCT across the centers. In this context, we sought to evaluate practice patterns of HCT in ALL patients using a large national database.Methods:We utilized the National Cancer Database (NCDB) Participant User File to extract patient-level data of adult patients (aged 18-80 years) diagnosed with ALL between 2003-2012. Patients with unknown HCT or chemotherapy status and those who did not receive chemotherapy were excluded. Only patients treated in the reporting facility were included. Data abstracted include age, sex, race, income, insurance, educational status, and HCT. Specific chemotherapy regimen, molecular data and data regarding minimal residual disease were not available in NCDB. Multivariate logistic regression analysis was performed to determine variables associated with the use of HCT.Results:Of 11,871 patients included in the study, 1502 patients (12.7%) received HCT. Patients who did versus did not receive HCT were more likely to be younger (median age 42 vs. 47 years; p <0.001), female (p<0.01), Caucasian (p<0.0001), treated at an academic facility (p <0.001), have higher educational status (p=0.001), higher income status (p <0.001), private insurance (p<0.0001) and lower Charlson comorbidity scores (p=0.001). In a multivariate analysis, age >60 years, male sex, higher Charlson comorbidity score, treatment at a non-academic center, poor educational status and Medicare/Medicaid insurance or uninsured status were associated with a significantly lower likelihood of receiving HCT (Table 1). Race and income status did not influence receipt of HCT.Conclusion:Our large study demonstrates variations in the HCT practices in ALL patients based on biological and non-biological factors. While a lower use of HCT in older patients or those with higher comorbidities is expected, variations based on facility type, insurance, educational status, and to some extent, gender may indicate a possibility of health care disparity based on socioeconomic and health system factors. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.