Malignant disease cohort: patient, disease, and transplantation characteristics for children age 0-18 y who underwent first allogeneic HCT for malignant disease in the United States from 2006-2015 stratified by neighborhood poverty
| Characteristic . | n (%) . | P . | ||
|---|---|---|---|---|
| Total . | Low-poverty neighborhood* . | High-poverty neighborhood* . | ||
| No. of patients | 2053 (100) | 1754 (85) | 299 (15) | |
| No. of centers | 90 | 89 | 62 | |
| Follow-up of survivors, mo | ||||
| Median | 74 | 73 | 76 | |
| Range | 3-126 | 3-126 | 6-125 | |
| Age at transplantation, y | .10 | |||
| <4 | 511 (25) | 430 (25) | 81 (27) | |
| 4-9 | 636 (31) | 533 (30) | 103 (34) | |
| 10-18 | 906 (44) | 791 (45) | 115 (38) | |
| Male sex | 1183 (58) | 1008 (57) | 175 (59) | .73 |
| Race | <.001 | |||
| White | 1578 (77) | 1398 (80) | 180 (60) | |
| Black | 227 (11) | 150 (9) | 77 (26) | |
| Other | 167 (8) | 149 (8) | 18 (6) | |
| Missing | 81 (4) | 57 (3) | 24 (8) | |
| Ethnicity | <.001 | |||
| Non-Hispanic | 1469 (72) | 1319 (75) | 150 (50) | |
| Hispanic | 565 (28) | 417 (24) | 148 (49) | |
| Missing | 19 (<1) | 18 (1) | 1 (<1) | |
| Insurance type | <.001 | |||
| Private | 1205 (58) | 1098 (63) | 107 (36) | |
| Medicaid | 711 (35) | 547 (31) | 164 (55) | |
| Uninsured | 16 (<1) | 11 (<1) | 5 (2) | |
| Missing | 121 (5) | 98 (6) | 23 (8) | |
| Performance score before HCT | .71 | |||
| ≥80 | 1924 (94) | 1642 (94) | 282 (94) | |
| <80 | 71 (3) | 63 (4) | 8 (3) | |
| Missing | 58 (3) | 49 (3) | 9 (3) | |
| Diagnosis† | .17 | |||
| AML + MDS | 1016 (49) | 883 (50) | 133 (44) | |
| ALL + other acute leukemia | 911 (44) | 763 (44) | 148 (49) | |
| CML | 64 (3) | 57 (3) | 7 (2) | |
| Lymphoma | 62 (3) | 51 (3) | 11 (4) | |
| Disease status at transplantation‡ | .71 | |||
| Early | 916 (45) | 788 (45) | 128 (43) | |
| Intermediate | 800 (39) | 685 (39) | 115 (39) | |
| Advanced | 277 (13) | 232 (13) | 45 (15) | |
| NA (malignant disease) | 57 (3) | 47 (3) | 10 (3) | |
| Missing (malignant disease) | 3 (<1) | 2 (<1) | 1 (< 1) | |
| Donor graft type | .07 | |||
| HLA-identical sibling BM | 216 (11) | 187 (11) | 29 (10) | |
| HLA-identical sibling PB | 37 (2) | 31 (2) | 6 (2) | |
| Cord blood | 1050 (51) | 893 (51) | 157 (53) | |
| Other related BM | 47 (2) | 42 (2) | 5 (2) | |
| Other related PB | 39 (2) | 26 (1) | 13 (4) | |
| Well-matched unrelated BM | 329 (16) | 288 (16) | 41 (14) | |
| Well-matched unrelated PB | 104 (5) | 93 (5) | 11 (4) | |
| Partially matched unrelated BM | 122 (6) | 100 (6) | 22 (7) | |
| Partially matched unrelated PB | 69 (3) | 59 (3) | 10 (3) | |
| Mismatched unrelated BM/PB | 40 (2) | 35 (2) | 5 (2) | |
| Donor age, y | .60‖ | |||
| Median | 32 | 31 | 34 | |
| Range | 16-61 | 16-61 | 19-58 | |
| Sex match (donor/recipient) | .66 | |||
| Male/male | 355 (17) | 306 (17) | 49 (16) | |
| Male/female | 231(11) | 200 (11) | 31 (10) | |
| Female/male | 234 (11) | 193 (11) | 41 (14) | |
| Female/female | 182 (9) | 161 (9) | 21 (7) | |
| Cord blood/male | 594 (29) | 509 (29) | 85 (28) | |
| Cord blood/female | 456 (22) | 384 (22) | 72 (24) | |
| Missing | 1 (< 1) | 1 (< 1) | 0 | |
| Recipient CMV | .10 | |||
| Negative | 910 (44) | 786 (45) | 124 (41) | |
| Positive | 1123 (55) | 954 (54) | 169 (57) | |
| Missing | 20 (1) | 14 (< 1) | 6 (2) | |
| Conditioning intensity (myeloablative) | .59 | |||
| TBI | 1278 (62) | 1096 (62) | 182 (61) | |
| Chemotherapy | 775 (38) | 658 (38) | 117 (39) | |
| GVHD prophylaxis | .44 | |||
| Ex vivo T-cell depletion + CD34 selection | 104 (5) | 83 (5) | 21 (7) | |
| Post-HCT cyclophosphamide + other(s) | 16 (<1) | 15 (<1) | 1 (<1) | |
| Tacrolimus based | 746 (36) | 631 (36) | 115 (38) | |
| Cyclosporin based | 1148 (56) | 991 (56) | 157 (53) | |
| Other | 15 (<1) | 13 (<1) | 2 (<1) | |
| Missing | 24 (1) | 21 (1) | 3 (1) | |
| Year of transplantation | .27 | |||
| 2006-2008 | 938 (46) | 801 (45) | 137 (46) | |
| 2009-2011 | 656 (32) | 570 (32) | 86 (29) | |
| 2012-2015 | 459 (22) | 383 (22) | 76 (25) | |
| Characteristic . | n (%) . | P . | ||
|---|---|---|---|---|
| Total . | Low-poverty neighborhood* . | High-poverty neighborhood* . | ||
| No. of patients | 2053 (100) | 1754 (85) | 299 (15) | |
| No. of centers | 90 | 89 | 62 | |
| Follow-up of survivors, mo | ||||
| Median | 74 | 73 | 76 | |
| Range | 3-126 | 3-126 | 6-125 | |
| Age at transplantation, y | .10 | |||
| <4 | 511 (25) | 430 (25) | 81 (27) | |
| 4-9 | 636 (31) | 533 (30) | 103 (34) | |
| 10-18 | 906 (44) | 791 (45) | 115 (38) | |
| Male sex | 1183 (58) | 1008 (57) | 175 (59) | .73 |
| Race | <.001 | |||
| White | 1578 (77) | 1398 (80) | 180 (60) | |
| Black | 227 (11) | 150 (9) | 77 (26) | |
| Other | 167 (8) | 149 (8) | 18 (6) | |
| Missing | 81 (4) | 57 (3) | 24 (8) | |
| Ethnicity | <.001 | |||
| Non-Hispanic | 1469 (72) | 1319 (75) | 150 (50) | |
| Hispanic | 565 (28) | 417 (24) | 148 (49) | |
| Missing | 19 (<1) | 18 (1) | 1 (<1) | |
| Insurance type | <.001 | |||
| Private | 1205 (58) | 1098 (63) | 107 (36) | |
| Medicaid | 711 (35) | 547 (31) | 164 (55) | |
| Uninsured | 16 (<1) | 11 (<1) | 5 (2) | |
| Missing | 121 (5) | 98 (6) | 23 (8) | |
| Performance score before HCT | .71 | |||
| ≥80 | 1924 (94) | 1642 (94) | 282 (94) | |
| <80 | 71 (3) | 63 (4) | 8 (3) | |
| Missing | 58 (3) | 49 (3) | 9 (3) | |
| Diagnosis† | .17 | |||
| AML + MDS | 1016 (49) | 883 (50) | 133 (44) | |
| ALL + other acute leukemia | 911 (44) | 763 (44) | 148 (49) | |
| CML | 64 (3) | 57 (3) | 7 (2) | |
| Lymphoma | 62 (3) | 51 (3) | 11 (4) | |
| Disease status at transplantation‡ | .71 | |||
| Early | 916 (45) | 788 (45) | 128 (43) | |
| Intermediate | 800 (39) | 685 (39) | 115 (39) | |
| Advanced | 277 (13) | 232 (13) | 45 (15) | |
| NA (malignant disease) | 57 (3) | 47 (3) | 10 (3) | |
| Missing (malignant disease) | 3 (<1) | 2 (<1) | 1 (< 1) | |
| Donor graft type | .07 | |||
| HLA-identical sibling BM | 216 (11) | 187 (11) | 29 (10) | |
| HLA-identical sibling PB | 37 (2) | 31 (2) | 6 (2) | |
| Cord blood | 1050 (51) | 893 (51) | 157 (53) | |
| Other related BM | 47 (2) | 42 (2) | 5 (2) | |
| Other related PB | 39 (2) | 26 (1) | 13 (4) | |
| Well-matched unrelated BM | 329 (16) | 288 (16) | 41 (14) | |
| Well-matched unrelated PB | 104 (5) | 93 (5) | 11 (4) | |
| Partially matched unrelated BM | 122 (6) | 100 (6) | 22 (7) | |
| Partially matched unrelated PB | 69 (3) | 59 (3) | 10 (3) | |
| Mismatched unrelated BM/PB | 40 (2) | 35 (2) | 5 (2) | |
| Donor age, y | .60‖ | |||
| Median | 32 | 31 | 34 | |
| Range | 16-61 | 16-61 | 19-58 | |
| Sex match (donor/recipient) | .66 | |||
| Male/male | 355 (17) | 306 (17) | 49 (16) | |
| Male/female | 231(11) | 200 (11) | 31 (10) | |
| Female/male | 234 (11) | 193 (11) | 41 (14) | |
| Female/female | 182 (9) | 161 (9) | 21 (7) | |
| Cord blood/male | 594 (29) | 509 (29) | 85 (28) | |
| Cord blood/female | 456 (22) | 384 (22) | 72 (24) | |
| Missing | 1 (< 1) | 1 (< 1) | 0 | |
| Recipient CMV | .10 | |||
| Negative | 910 (44) | 786 (45) | 124 (41) | |
| Positive | 1123 (55) | 954 (54) | 169 (57) | |
| Missing | 20 (1) | 14 (< 1) | 6 (2) | |
| Conditioning intensity (myeloablative) | .59 | |||
| TBI | 1278 (62) | 1096 (62) | 182 (61) | |
| Chemotherapy | 775 (38) | 658 (38) | 117 (39) | |
| GVHD prophylaxis | .44 | |||
| Ex vivo T-cell depletion + CD34 selection | 104 (5) | 83 (5) | 21 (7) | |
| Post-HCT cyclophosphamide + other(s) | 16 (<1) | 15 (<1) | 1 (<1) | |
| Tacrolimus based | 746 (36) | 631 (36) | 115 (38) | |
| Cyclosporin based | 1148 (56) | 991 (56) | 157 (53) | |
| Other | 15 (<1) | 13 (<1) | 2 (<1) | |
| Missing | 24 (1) | 21 (1) | 3 (1) | |
| Year of transplantation | .27 | |||
| 2006-2008 | 938 (46) | 801 (45) | 137 (46) | |
| 2009-2011 | 656 (32) | 570 (32) | 86 (29) | |
| 2012-2015 | 459 (22) | 383 (22) | 76 (25) | |
ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CML, chronic myeloid leukemia; CMV, cytomegalovirus; MDS, myelodysplastic syndrome; TBI, total-body irradiation.
Neighborhood poverty defined by linkage of a child’s residential ZIP code at the time of HCT to US Census3 and categorized as high-poverty neighborhood (≥20% of persons living below 100% FPL) or low-poverty neighborhood (<20% of persons below 100% FPL).1-4
Absolute n for disease subtype by neighborhood poverty group. Low poverty: AML (n = 686), MDS (n = 197), ALL (n = 724), CLL (n = 2), other acute leukemia (n = 37), Hodgkin lymphoma (n = 2), non-Hodgkin lymphoma (n = 49); high poverty: AML (n = 108), MDS (n = 25), ALL (n = 138), other acute leukemia (n = 10), non-Hodgkin lymphoma (n = 11).
Disease status defined as follows: early: AML/ALL (first complete remission), CML (first chronic phase), MDS (refractory anemia/refractory anemia with ringed sideroblasts/pre-HCT marrow blasts <5%); intermediate: AML/ALL (≥second complete remission), CML (accelerated phase or ≥second chronic phase); advanced: AML/ALL (active relapsed disease/primary induction failure), CML (blast phase), MDS (refractory anemia with excess blasts/chronic myelomonocytic leukemia or marrow blasts ≥5%).
Kruskal-Wallis test used for hypothesis testing; all others used Pearson χ2 test.