Hematology, Transfusion and Cell Therapy

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Original article • Hematol., Transfus. Cell Ther. 46 (3) • 2024 • https://doi.org/10.1016/j.htct.2023.03.021 linkcopy

Impact of waitlist time on post-HSCT survival: a cohort study at a hospital in southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction The time elapsed from diagnosis to hematopoietic stem cell transplantation (HSCT) is influenced by numerous factors. In Brazil, patients using the public health system are also dependent on the availability of HSCT-specific beds in the hematology ward.

Objective and Methods We conducted a cohort study of listed patients who underwent allogeneic HSCT at a Brazilian public hospital to investigate the impact of the waitlist time on post-HSCT survival.

Results The median time from diagnosis to HSCT was 19 months (IQR, 10 - 43), of which 6 months (IQR, 3 - 9) were spent on the waitlist. The time on the waitlist for HSCT appeared to influence mainly the survival of adult patients (≥ 18 years), with an increasing risk according to this time (RR, 3.53 and 95%CI, 1.81 - 6.88 for > 3 and ≤ 6 months; RR 5.86 and 95%CI, 3.26 - 10.53 for > 6 and ≤ 12 months, and; RR 4.24 and 95%CI, 2.32 - 7.75 for > 12 months).

Conclusion Patients who remained on the waitlist for less than 3 months had the highest survival (median survival, 856 days; IQR, 131 - 1607). The risk of reduced survival was about 6-fold higher (95%CI, 2.8 - 11.5) in patients with malignancies.

Keywords
Hematopoietic stem cell transplantation; Bone marrow transplantation; Survival analysis; Waitlists; Health services accessibility

	All patients		Pediatric patients		Adult patients		P Value
Survival (days)	374	[103-1020]	492	[128-1097.5]	270	[84-894.5]	0.061
Time on the waiting list (days)	176.5	[101.75-262.5]	180	[112-276]	170	[96.5-247.5]	0.352
Time from diagnosis to HSCT (months) ¹	19	[10- 43]	20	[12-44.5]	18	[9.5-40]	0.516
Age (years)	18	[1-34]	9	[4-13]	34	[24-47]
Hospitalization (days)	50	[39-73]	57	[44-79.25]	47	[36.5-64]	0.003*
Sex							0.548
Male	142	62.6	71	64.5	71	60.7
Female	85	37.4	39	35.5	76	39.3
Radiotherapy
<4 Gy	28	30.1	14	28.6	14	31.8
>9.9 Gy	65	69.9	35	71.4	30	68.2
Diagnosis							0.001*
Non-malignant
Aplasia	26	11.5	12	10.9	14	12
Genetic disease	11	4.8	11	10	-	-
Hemoglobinopathy	3	1.3	3	2.7	-	-
Primary immunodeficiency	19	8.4	19	17.3	-	-
Malignant
Lymphomas	14	6.2	3	2.7	11	9.4
Acute lymphocytic leukemia	67	29.5	39	35.5	28	23.9
Acute myeloid leucemia	50	22.0	12	10.9	38	32.5
Chronic lymphocytic and myeloid	13	5.7	2	1.8	11	9.4
Leucemia	13	5.7	2	1.8	11	9.4
Primary myelofibrosis	2	0.9	-	-	2	1.7
Myelodysplastic syndrome	22	9.7	9	8.2	13	11.1
Conditioning regimen							0.034*
Non-myeloablative	84	37	77	70	51	43.6
Myeloablative	143	63	33	30	66	56.4
Total-body irradiation							0.288
No	134	59	61	55.5	73	62.4
Yes	93	41	49	44.5	44	37.6
Time on waiting list							0.790
Up to 3 months	58	25.6	25	22.9	33	28.2
3 to 6 months	76	33.5	37	33.9	39	33.3
6 to 12 months	69	30.4	36	33	33	28.2
More than 12 months	23	10.1	11	10.1	12	10.3
Relapse on the waiting list²							0.368
No	136	82.4	54	85.7	81	80.2
Yes	29	17.6	9	14.3	20	19.8
Transplant donor							0.001*
HLA-identical sibling	95	41.9	28	25.5	67	57.3
Haploidentical donor	41	18.1	21	19.1	20	17.1
Matched Unrelated donor	91	40.1	61	55.5	30	25.6
Post-HSCT relapse							0.252
No	185	81.5	93	84.5	92	78.6
Yes	42	18.5	17	15.5	25	21.4
Acute graft-versus-host disease							0.012*
No	89	40.6	54	50.5	35	31.3
Yes	130	59.4	53	49.5	77	68.7
Chronic graft-versus-host disease							0.983
No	154	70.3	74	69.8	80	70.8
Yes	65	29.7	32	30.2	33	29.2

	All patients		Pediatric patients		Adult patients		Adult patients withmalignancies
	P Value	Relative risk	P Value	Relative risk	P Value	Relative risk	P Value	Relative risk
Sex (female)	0.00	1.78	0.00	2.31	0.00	1.82	0.00	1.83
Diagnosis	0.00	1.25	0.00	1.26	0.00	1.23	0.50	1.05
Relapse on the waiting list	0.00	1.58	0.01	1.71	0.01	1.68	0.01	1.66
Conditioning regimen	0.58	1.15	0.01	1.73	0.14	1.63	0.28	1.40
Stem-cell source	0.01	1.42	0.00	3.02	0.00	1.88	0.00	2.11
Radiation dose >9.9 Gy	0.00	1.35	^a		0.09	1.21	^a
Acute graft-versus-host disease	0.00	0.72	0.00	0.56	0.05	1.34	0.09	1.28
Chronic graft-versus-host disease	0.00	0.72	0.02	0.66	0.09	0.77	0.03	0.71
Age	0.06	1.08	0.00	2.17	0.00	0.79	0.00	0.76
Time from diagnosis to HSCT	0.04	1.12	0.00	0.76	0.00	1.50	0.00	1.52
Time on waiting list
≤3 months	0.00		0.00		0.00		0.00
>3 and ≤6 months	0.06	1.43	0.12	1.65	0.00	3.53	0.00	4.41
>6 and ≤12 months	0.00	1.59	0.17	0.74	0.00	5.86	0.00	6.67
>12 months	0.55	1.09	0.05	0.67	0.00	4.24	0.00	4.86

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Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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