Community health status and outcomes after allogeneic hematopoietic cell transplantation in the United States

Sanghee Hong, Ruta Brazauskas, Kyle M. Hebert, Siddhartha Ganguly, Hisham Abdel-Azim, Miguel Angel Diaz, Sara Beattie, Stefan O. Ciurea, David Szwajcer, Sherif M. Badawy, Alois A. Gratwohl, Charles LeMaistre, Mahmoud D.S.M. Aljurf, Richard F. Olsson, Neel S. Bhatt, Nosha Farhadfar, Jean A. Yared, Ayami Yoshimi, Sachiko Seo, Usama GergisAmer M. Beitinjaneh, Akshay Sharma, Hillard Lazarus, Jason Law, Matthew Ulrickson, Hasan Hashem, Hélène Schoemans, Jan Cerny, David Rizzieri, Bipin N. Savani, Rammurti T. Kamble, Bronwen E. Shaw, Nandita Khera, William A. Wood, Shahrukh Hashmi, Theresa Hahn, Stephanie J. Lee, J. Douglas Rizzo, Navneet S. Majhail, Wael Saber

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: The association of community factors and outcomes after hematopoietic cell transplantation (HCT) has not been comprehensively described. Using the County Health Rankings and Roadmaps (CHRR) and the Center for International Blood and Marrow Transplant Research (CIBMTR), this study evaluated the impact of community health status on allogeneic HCT outcomes. Methods: This study included 18,544 adult allogeneic HCT recipients reported to the CIBMTR by 170 US centers in 2014-2016. Sociodemographic, environmental, and community indicators were derived from the CHRR, an aggregate community risk score was created, and scores were assigned to each patient (patient community risk score [PCS]) and transplant center (center community risk score [CCS]). Higher scores indicated less healthy communities. The impact of PCS and CCS on patient outcomes after allogeneic HCT was studied. Results: The median age was 55 years (range, 18-83 years). The median PCS was –0.21 (range, –1.37 to 2.10; standard deviation [SD], 0.42), and the median CCS was –0.13 (range, –1.04 to 0.96; SD, 0.40). In multivariable analyses, a higher PCS was associated with inferior survival (hazard ratio [HR] per 1 SD increase, 1.04; 99% CI, 1.00-1.08; P =.0089). Among hematologic malignancies, a tendency toward inferior survival was observed with a higher PCS (HR, 1.04; 99% CI, 1.00-1.08; P =.0102); a higher PCS was associated with higher nonrelapse mortality (NRM; HR, 1.08; 99% CI, 1.02-1.15; P =.0004). CCS was not significantly associated with survival, relapse, or NRM. Conclusions: Patients residing in counties with a worse community health status have inferior survival as a result of an increased risk of NRM after allogeneic HCT. There was no association between the community health status of the transplant center location and allogeneic HCT outcomes.

Original languageEnglish (US)
Pages (from-to)609-618
Number of pages10
Issue number4
StatePublished - Feb 15 2021


  • allogeneic transplant
  • community health
  • hematopoietic cell transplantation
  • survival
  • Public Health/statistics & numerical data
  • Hematopoietic Stem Cell Transplantation/statistics & numerical data
  • Humans
  • Middle Aged
  • Risk Factors
  • Community Health Planning
  • Neoplasm Recurrence, Local/epidemiology
  • Male
  • Treatment Outcome
  • Young Adult
  • Transplantation, Homologous/statistics & numerical data
  • United States/epidemiology
  • Adolescent
  • Aged, 80 and over
  • Hematologic Neoplasms/epidemiology
  • Adult
  • Female
  • Aged

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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