Disparity in Utilization of Multiagent Therapy for Acute Promyelocytic Leukemia in the United States.
Disparity in Utilization of Multiagent Therapy for Acute Promyelocytic Leukemia in the United States.
复制标题
美国急性早幼粒细胞白血病多药治疗的利用差异。
DOI：
10.1016/j.clml.2021.10.010
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Bhatt,VijayaRaj
中科院分区：
文献类型：
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作者：
Dhakal,Prajwal;Lyden,Elizabeth;Joshi,Utsav;Pyakuryal,Avantika;Gundabolu,Krishna;Zeidan,AmerM;Loh,KahPoh;Fisher,AlfredL;Bhatt,VijayaRaj
尽管在临床试验中急性早幼粒细胞白血病（APL）的治愈率很高，但在现实世界中的结果是令人沮丧的。我们利用国家癌症数据库（NCDB），探讨利用多药治疗APL，并确定在现实世界的practices.Patients和MethodsNCDB的治疗中的任何差异分类使用全身化疗单药与多药治疗。一些患者接受了激素治疗、免疫治疗和未知治疗;这些治疗的细节无法确定。因此，我们使用多元logistic回归分析来评估协变量对6678例患者使用多药治疗概率的影响。（风险比[HR] 3.2，95%置信区间[CI] 1.8- 5.5，P < .0001），19 - 40岁（HR 1.6，95%CI 1.03- 2.54，P = 0.03）和41 - 60岁（HR 1.6，95%CI 1.3- 1.9，P <0.0001）更可能接受多药治疗。Charlson合并症指数（CCI）为0（HR 1.6，95%CI 1.2- 2.3，P = .001）和CCI为1（HR 1.4，95%CI 1.0- 1.9，P = .04）的患者比CCI ≥ 3的患者接受多药治疗的可能性更高。在学术癌症中心接受治疗的患者与在社区癌症中心接受治疗的患者相比（HR 0.5，95% CI 0.3- 0.7，P = .001），综合社区癌症中心（HR 0.7，95%CI 0.6- 0.8，P <0.0001），综合网络癌症中心（HR 0.8，95%CI 0.6- 0.9，P = 0.02）更可能接受多药治疗。与有私人保险的患者相比，有医疗补助的患者（HR 1.2，95%CI 1.0- 1.4，P = 0.04）而未投保的患者接受多药治疗的可能性较低（HR 0.6，95%CI 0.5- 0.8，P = 0.0005）。这项研究是第一次也是最大规模的分析APL治疗实践在现实世界的做法。我们的研究结果强调了基于年龄，保险和健康系统因素的APL治疗的显着差异。
BackgroundDespite high rate of cure in acute promyelocytic leukemia (APL) in clinical trials, outcomes in real-world practice are dismal. We utilized National Cancer Database (NCDB) to explore utilization of multiagent therapy in APL and identify any disparities in treatment in real-world practices.Patients and MethodsNCDB categorizes use of systemic chemotherapy into single agent versus multiagent therapy. Some patients received hormonal therapy, immunotherapy, and unknown therapy; details of these treatments could not be ascertained. We therefore used multiple logistic regression analysis to evaluate effects of covariates on the probability of multiagent therapy use in 6678 patients.ResultsCompared to patients >60 years, patients aged 0 to 18 years (hazard ratio[HR] 3.2, 95% confidence interval [CI] 1.8-5.5,P< .0001), 19 to 40 years (HR 1.6, 95% CI 1.03-2.54,P= .03), and 41 to 60 years (HR 1.6, 95% CI 1.3-1.9,P< .0001) were more likely to receive multiagent therapy. Patients with Charlson comorbidity index (CCI) of 0 (HR 1.6, 95% CI 1.2-2.3,P= .001) and CCI of 1 (HR 1.4, 95% CI 1.0-1.9,P= .04) had a higher likelihood of receiving multiagent therapy than patients with CCI ≥ 3. Patients treated at academic cancer centers, compared to those treated at community cancer center (HR 0.5, 95% CI 0.3-0.7,P= .001), comprehensive community cancer center (HR 0.7, 95% CI 0.6-0.8,P< .0001), and integrated network cancer center (HR 0.8, 95% CI 0.6-0.9,P= .02) were more likely to be treated with multiagent therapy. Compared to the patients with private insurance, those with Medicaid had increased likelihood (HR 1.2, 95% CI 1.0-1.4,P= .04) whereas uninsured patients had a lower likelihood of receiving multiagent therapy (HR 0.6, 95% CI 0.5-0.8,P= .0005).ConclusionTo our knowledge, this study is the first and the largest scale analysis of treatment practices in APL in real-world practices. Our findings highlight significant disparities in treatment of APL based on age, insurance, and health-system factors.