The Impact of Geographic Proximity to Transplant Center on Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation
The Impact of Geographic Proximity to Transplant Center on Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation
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DOI：
10.1016/j.bbmt.2011.08.022
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发表时间：
2012-05-01
影响因子：
4.3
通讯作者：
Armand, Philippe
中科院分区：
文献类型：
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作者：
Abou-Nassar, Karim E.;Kim, Haesook T.;Armand, Philippe
接受异基因造血干细胞移植(HSCT)的患者需要获得专门的护理。我们推测，HSCT后进入移植中心对居住在地理位置遥远地区的患者来说可能是一种挑战，这将对他们的预后产生不利影响。我们分析了1996至2009年间在Dana-Farber/Brigham和妇女癌症中心(DF/BWCC)接受异基因HSCT的1912名成年患者，他们居住在该机构6小时车程内。利用地理信息系统，基于邮政编码确定了从主要居住地到DF/BWCC的驾驶时间。至DF/BWCC的中位驾驶时间(里程)为72(2~358)分钟。当患者按驾驶时间四分位数分层时，HSCT后第一年的总存活率(OS)在前四分位数(>；=160分钟驾驶时间)的患者中相似，但在第一年后更差。在一项里程碑式的分析中，909名在第一年存活且无病的患者，前四分位数(=160分钟)患者的5年OS分别为76%和65%(P=0.027)。这一点在多变量分析中得到了证实。这一差异似乎主要是因为无复发死亡率的增加。HSCT后第100天至365天期间前往移植中心就诊的次数随着驾车前往移植中心的时间增加而显著减少，这独立地与较差的存活率相关。与其他与患者、疾病和HSCT相关的变量无关，长时间开车到移植中心与存活的和HSCT后一年无病的患者的OS更差相关。这可能在一定程度上与HSCT后就诊频率较低有关，这些患者居住在较远的地方。生物骨髓移植18：708-715(2012)(C)2012美国血液和骨髓移植学会
Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) need access to specialized care. We hypothesized that access to the transplant center after HSCT may be challenging for patients living in geographically distant areas, and that this would have an adverse effect on their outcome. We analyzed 1912 adult patients who underwent allogeneic HSCT at the Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) between 1996 and 2009 and who resided within 6 hours driving time of the institution. Driving time from primary residence to DF/BWCC based on zipcode was determined using geographic information systems. The median driving time (range) to DF/BWCC was 72 (2-358) minutes. When patients were stratified by driving time quartile, overall survival (OS) after HSCT was similar in the first year but worse after I year in patients in the top quartile (>= 160 minutes driving time). In a landmark analysis of the 909 patients alive and free of disease at I year, 5-year OS was 76% and 65% for patients in the first (= 160 minutes) quartiles, respectively (P = .027). This was confirmed in a multivariable analysis. The difference appeared to be mostly because of an increase in nonrelapse mortality. The number of visits to the transplant center between day 100 and 365 after HSCT declined significantly with increasing driving time to the transplant center, which was independently associated with worse survival. Long driving time to the transplant center is associated with worse OS in patients alive and disease-free 1 year after HSCT, independently of other patient-, disease-, and HSCT-related variables. This may be in part related to the lower frequency of post-HSCT visits in patients living farther away. Biol Blood Marrow Transplant 18: 708-715 (2012) (C) 2012 American Society for Blood and Marrow Transplantation