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Linking the Center for International Blood and Marrow Transplant Research (CIBMTR) Registry to the California Cancer Registry and California Hospital Patient Discharge Data
Keegan, T. H. M., Brunson, A., Cooley, J. J. P., Schonfeld, S. J., Meyer, C. L., Valcarcel, B., Abrahao, R., Wun, T., Auletta, J., Muffly, L., et al
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Advances in hematopoietic cell transplant (HCT) have substantially improved patient survival, increasing the importance of studying outcomes and long-term adverse effects in the rapidly growing population of HCT survivors. Large-scale registry data from the Center for International Blood and Marrow Transplant Research (CIBMTR) are a valuable resource for studying mortality and late effects after HCT, with detailed data reported by HCT centers on transplant-related factors and key outcomes. OBJECTIVE To evaluate the robustness of CIBMTR outcome data and to assess health-related outcomes and healthcare utilization among HCT recipients, we linked data from the CIBMTR for California residents with the population-based California Cancer Registry (CCR) and hospitalization information from the California Patient Discharge Database (PDD). STUDY DESIGN In this retrospective cohort study, probabilistic and deterministic record linkage utilized key patient identifiers, such as social security number, zip code, sex, birth date, hematologic malignancy type and diagnosis date, and HCT type and date. RESULTS Among 22,733 patients in the CIBMTR who received autologous or allogeneic HCT for hematologic malignancy during 1991-2016, 89.0% were matched to the CCR and/or PDD (N=17,707 [77.9%] both; N=1179 [5.2%] CCR only; N=1342 [5.9%] PDD only). Unmatched patients were slightly more likely to have a first autologous (12.6%) than allogeneic (9.0%) HCT, a higher number of missing linkage identifiers, and to have received their HCT occurring prior to 2010. Among the patients reported to CIBMTR who matched to CCR, 85.7% demonstrated concordance of both hematologic malignancy type and diagnosis date across data sources. CONCLUSION This linkage presents unparalleled opportunities to advance understanding of HCT practices and patient outcomes.
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Reimbursement, Utilization, and 1-Year Survival Post-Allogeneic Transplantation for Medicare Beneficiaries With Acute Myeloid Leukemia
Mau, L. W., Meyer, C., Burns, L. J., Saber, W., Steinert, P., Vanness, D. J., Preussler, J. M., Silver, A., Leppke, S., Murphy, E. A., et al
JNCI cancer spectrum. 2019;3(4):pkz048
Abstract
Background: The economics of allogeneic hematopoietic cell transplantation (alloHCT) for older patients with acute myeloid leukemia (AML) affects clinical practice and public policy. To assess reimbursement, utilization, and overall survival (OS) up to 1 year post-alloHCT for Medicare beneficiaries aged 65 years or older with AML, a unique merged dataset of Medicare claims and national alloHCT registry data was analyzed. Methods: Patients diagnosed with AML undergoing alloHCT from 2010 to 2011 were included for a retrospective cohort analysis with generalized linear model adjustment. One-year post-alloHCT reimbursement included Medicare, secondary payer, and beneficiary copayments (no coinsurance) (inflation adjusted to 2017 dollars). Cost-to-charge ratios were applied to estimate department-specific inpatient costs. Cox proportional hazards regression models were utilized to identify risk factors of 1-year OS post-alloHCT. Results: A total of 250 patients met inclusion criteria. Mean total reimbursement was $230 815 (95% confidence interval [CI] = $214 381 to $247 249) 1 year after alloHCT. Pharmacy was the most- costly inpatient service category. Adjusted mean total reimbursement was statistically higher for patients who received cord blood grafts (P = .01), myeloablative conditioning (P < .0001), and alloHCT in the Northeast and West (P = .03). Mortality increased with age (hazard ratio [HR] = 1.08, 95% CI = 1.0 to 1.17), poorer Karnofsky performance score (<90% vs ≥90%, HR = 1.60, 95% CI = 1.08 to 2.35), and receipt of myeloablative conditioning (HR = 1.88, 95% CI = 1.21 to 2.92). Conclusions: This merged dataset allowed adjustment for a richer set of patient- and HCT-related characteristics than claims data alone. The finding that nonmyeloablative conditioning was associated with lower reimbursement and improved OS 1 year post-alloHCT warrants further investigation.
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Association of Nutritional Parameters with Clinical Outcomes in Patients with Acute Myeloid Leukemia Undergoing Haematopoietic Stem Cell Transplantation
Baumgartner, A., Zueger, N., Bargetzi, A., Medinger, M., Passweg, J. R., Stanga, Z., Mueller, B., Bargetzi, M., Schuetz, P.
Annals of Nutrition & Metabolism. 2016;69(2):89-98
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Abstract
INTRODUCTION In acute myeloid leukemia (AML) patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), there is uncertainty about the extent of influence nutritional parameters have on clinical outcomes. In this study, we investigated the association between initial body mass index (BMI) and weight loss during HSCT on clinical outcomes in a well-characterised cohort of AML patients. METHODS We analysed data of the Basel stem-cell transplantation registry ('KMT Kohorte') including all patients with AML undergoing first allogeneic HSCT from January 2003 to January 2014. We used multivariable regression models adjusted for prognostic indicators (European Group for Blood and Marrow Transplantation risk score and cytogenetics). RESULTS Mortality in the 156 AML patients (46% female, mean age 46 years) over the 10 years of follow-up was 57%. Compared to patients with a baseline BMI (kg/m2) of 20-25, a low BMI <20 was associated with higher long-term mortality (70 vs. 49%, adjusted hazard ratio 1.97, 95% CI 1.04-3.71, p = 0.036). A more pronounced weight loss during HSCT (>7 vs. <2%) was associated with higher risk for bacterial infections (52 vs. 28%, OR 2.8, 95% CI 0.96-8.18, p = 0.059) and fungal infections (48 vs. 23%, OR 3.37, 95% CI 1.11-10.19, p = 0.032), and longer hospital stays (64 vs. 38 days, adjusted mean difference 25.6 days (15.7-35.5), p < 0.001). CONCLUSION In patients with AML, low initial BMI and more pronounced weight loss during HSCT are strong prognostic indicators associated with lower survival and worse disease outcomes. Intervention research is needed to investigate whether nutritional therapy can reverse these associations.Copyright © 2016 S. Karger AG, Basel.