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FältnamnIndikatorerMetadata
00009380naa a2200889 4500
001oai:DiVA.org:uu-341360
003SwePub
008180212s2017 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:136924520
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3413602 URI
0247 a https://doi.org/10.3324/haematol.2017.1695812 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1369245202 URI
040 a (SwePub)uud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Arnold, Staci D.u Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.4 aut
2451 0a Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases
264 c 2017-08-17
264 1b Ferrata Storti Foundation (Haematologica),c 2017
338 a electronic2 rdacarrier
520 a Advances in allogeneic hematopoietic cell transplantation for sickle cell disease have improved outcomes, but there is limited analysis of healthcare utilization in this setting. We hypothesized that, compared to late transplantation, early transplantation (at age < 10 years) improves outcomes and decreases healthcare utilization. We performed a retrospective study of children transplanted for sickle cell disease in the USA during 2000-2013 using two large databases. Univariate and Cox models were used to estimate associations of demographics, sickle cell disease severity, and transplant-related variables with mortality and chronic graft-versus-host disease, while Wilcoxon, Kruskal-Wallis, or linear trend tests were applied for the estimates of healthcare utilization. Among 161 patients with a 2-year overall survival rate of 90% (95% confidence interval [CI] 85-95%) mortality was significantly higher in those who underwent late transplantation versus early (hazard ratio (HR) 21, 95% CI 2.8-160.8, P=0.003) and unrelated compared to matched sibling donor transplantation (HR 5.9, 95% CI 1.7-20.2, P=0.005). Chronic graftversus host disease was significantly more frequent among those translanted late (HR 1.9, 95% CI 1.0-3.5, P=0.034) and those who received an unrelated graft (HR 2.5, 95% CI 1.2-5.4; P=0.017). Merged data for 176 patients showed that the median total adjusted transplant cost per patient was $467,747 (range: $344,029-$ 799,219). Healthcare utilization was lower among recipients of matched sibling donor grafts and those with low severity disease compared to those with other types of donor and disease severity types (P<0.001 and P=0.022, respectively); no association was demonstrated with late transplantation (P=0.775). Among patients with 2-year pre-and post-transplant data (n=41), early transplantation was associated with significant reductions in admissions (P<0.001), length of stay (P<0.001), and cost (P=0.008). Early transplant outcomes need to be studied prospectively in young children without severe disease and an available matched sibling to provide conclusive evidence for the superiority of this approach. Reduced post-transplant healthcare utilization inpatient care indicates that transplantation may provide a sustained decrease in healthcare costs over time.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Hematologi0 (SwePub)302022 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Hematology0 (SwePub)302022 hsv//eng
7001 a Brazauskas, Rutau Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.4 aut
7001 a He, Nayau Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.4 aut
7001 a Li, Yimeiu Univ Penn, Philadelphia, PA 19104 USA.4 aut
7001 a Aplenc, Richardu Univ Penn, Philadelphia, PA 19104 USA.4 aut
7001 a Jin, Zhezhenu Columbia Univ, Mailman Sch Publ Hlth, Dept Biostat, New York, NY USA.4 aut
7001 a Hall, Mattu Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.4 aut
7001 a Atsuta, Yoshikou Japanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan.;Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan.4 aut
7001 a Dalal, Jigneshu Rainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.4 aut
7001 a Hahn, Theresau Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA.4 aut
7001 a Khera, Nanditau Mayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.4 aut
7001 a Bonfim, Carmemu Univ Fed Parana, Hosp Clin, Curitiba, Parana, Brazil.4 aut
7001 a Majhail, Navneet S.u Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA.4 aut
7001 a Diaz, Miguel Angelu Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.4 aut
7001 a Freytes, Cesar O.u Texas Transplant Inst, San Antonio, TX USA.4 aut
7001 a Wood, William A.u Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA.4 aut
7001 a Savani, Bipin N.u Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.4 aut
7001 a Kamble, Rammurti T.u Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.4 aut
7001 a Parsons, Susanu Tufts Med Ctr, Boston, MA USA.4 aut
7001 a Ahmed, Ibrahimu Rainbow Babies & Childrens Hosp, 2101 Adelbert Rd, Cleveland, OH 44106 USA.4 aut
7001 a Sullivan, Keithu Duke Univ, Med Ctr, Durham, NC USA.4 aut
7001 a Beattie, Sarau Univ Ottawa, Ottawa, ON, Canada.4 aut
7001 a Dandoy, Christopheru Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.4 aut
7001 a Munker, Reinholdu Louisiana State Univ Hlth Shreveport, Dept Internal Med, Sect Hematol Oncol, Shreveport, LA USA.4 aut
7001 a Marino, Susanau Univ Chicago Hosp, Chicago, IL 60637 USA.4 aut
7001 a Bitan, Menachemu Tel Aviv Sourasky Med Ctr, Dept Pediat Hematol Oncol, Tel Aviv, Israel.4 aut
7001 a Abdel-Azim, Hishamu Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA.4 aut
7001 a Aljurf, Mahmoudu King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riydah, Saudi Arabia.4 aut
7001 a Olsson, Richard F.u Karolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden4 aut0 (Swepub:uu)riols677
7001 a Joshi, Saritau Nationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.4 aut
7001 a Buchbinder, Daveu Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.4 aut
7001 a Eckrich, Michael J.u Levine Childrens Hosp, Charlotte, NC USA.4 aut
7001 a Hashmi, Shahrukhu Mayo Clin, Dept Internal Med, Minneapolis, MN USA.4 aut
7001 a Lazarus, Hillardu Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA.4 aut
7001 a Marks, David I.u Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.4 aut
7001 a Steinberg, Amiru Mt Saini Hosp, Dept Hematol Oncol, New York, NY USA.4 aut
7001 a Saad, Aymanu Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL USA.4 aut
7001 a Gergis, Usamau New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA.4 aut
7001 a Krishnamurti, Lakshmananu Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.4 aut
7001 a Abraham, Allistairu Childrens Natl Med Ctr, Ctr Canc & Blood Disorders, Div Blood & Marrow Transplantat, Washington, DC 20010 USA.4 aut
7001 a Rangarajan, Hemalatha G.u Nationwide Childrens Hosp, Pediat Hematol Oncol & BMT, Columbus, OH USA.;Ohio State Univ Wexner, Columbus, OH USA.4 aut
7001 a Walters, Marku Childrens Hosp & Res Ctr Oakland, Oakland, NY USA.4 aut
7001 a Lipscomb, Josephu Emory Univ, Winship Canc Inst, Rollins Sch Publ Hlth, Hlth Policy & Management, Atlanta, GA 30322 USA.4 aut
7001 a Saber, Waelu Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.4 aut
7001 a Satwani, Prakashu Columbia Univ, Med Ctr, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, New York, NY USA.4 aut
7102 a Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA.b Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.4 org
7730 t Haematologicad : Ferrata Storti Foundation (Haematologica)g 102:11, s. 1823-1832q 102:11<1823-1832x 0390-6078x 1592-8721
8564 u https://doi.org/10.3324/haematol.2017.169581y Fulltext
8564 u https://uu.diva-portal.org/smash/get/diva2:1181944/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 u https://doi.org/10.3324/haematol.2017.169581
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-341360
8564 8u https://doi.org/10.3324/haematol.2017.169581
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:136924520

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