Analysis of Distribution and Access Time to Transplant in Patients with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia in Brazil (2016-2022)

Authors

DOI:

https://doi.org/10.32635/2176-9745.RBC.2024v70n4.4749

Keywords:

Hematopoietic Stem Cell Transplantation/statistics & numerical data, Acute Myeloid Leukemia, recursor Cell Lymphoblastic Leukemia-Lymphoma, Waiting Lists, Health Services Accessibility

Abstract

Introduction: Bone marrow transplantation is a crucial treatment for patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Analyzing demographic distribution and access time to transplantation provides insights into disparities in treating these conditions. Objective: To analyze the distribution of patients with ALL and AML and identify factors influencing the time to transplantation in Brazil between 2016 and 2022. Method: Data from 11,908 patient records from Redome-net were collected, with 1,129 transplanted patients included in the statistical analysis. Shapiro-Wilk test for normality, Levene’s test for homogeneity, and Kruskal-Wallis and Mann-Whitney tests for median comparisons were used, with a 95% significance level. Variables such as sex, race/color, age group, type of service, and state were analyzed. Results: Most patients were male (57%) and adult (62%), with a predominance of White individuals (59%). Only 19% of the patients were transplanted. Older patients and those from the public system had longer median waiting times. Significant differences were observed between states, with Paraná showing the shortest waiting time. Conclusion: The study revealed regional and sociodemographic disparities in the time to bone marrow transplantation in Brazil. Older patients and those from the public system face longer waiting times, highlighting the need for improvements in healthcare infrastructure and equitable access to treatment. These findings emphasize the importance of health policies targeted to reduce inequalities and optimizing treatment for patients with acute leukemias.

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References

Assunção F. Doação de medula óssea no Brasil: compatibilidade HLA e métodos de coleta. [Monografia][Internet]. Caxias do Sul: Universidade de Caxias do Sul; 2022. [acesso 2024 set 10]. Disponível em: https://repositorio.ucs.br/xmlui/bitstream/handle/11338/12036/TCC%20Fernanda%20de%20 Assuncao.pdf?sequence=1&isAllowed=y.

Khaddour K, Hana CK, Mewawalla P. Hematopoietic stem cell transplantation. Em: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2023. [acesso 2023 maio 10, atualizado em 2023 maio 6]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK536951/.

Jo T, Arai Y, Kondo T, et al. Advantages of peripheral blood stem cells from unrelated donors versus bone marrow transplants in outcomes of adult acute myeloid leukemia patients. Cytotherapy. 2022;24(10):1013-25. doi: https://doi.org/10.1016/j.jcyt.2022.05.009 DOI: https://doi.org/10.1016/j.jcyt.2022.05.009

Santos IJ, Gonçalves JFF, Brandão LFS. Transplante de medula óssea: importância do sistema HLA [monografia][Internet]. Pouso Alegre: Centro Universitário UNA; 2022. [acesso 2024 set 10]. Disponível em: https://repositorio.animaeducacao.com.br/items/56f7c8b4-2a5f-4210-9a56-b768e57e1e79

Santis JO. Frequência dos antígenos HLA classe I e II em pacientes indicados para transplante de medula óssea na região de Ribeirão Preto - SP. [Monografia] [Internet]. Ribeirão Preto: Universidade de São Paulo; 2018. [acesso 2024 set 10]. Disponível em: https://docs.bvsalud.org/biblioref/2019/05/996719/pap_santisjo_2018.pdf

Instituto Nacional de Câncer. Estimativa 2023: incidência de câncer no Brasil [Internet]. Rio de Janeiro: Instituto Nacional de Câncer; 2022. [acesso 2024 set 10]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2023.pdf.

He P, Liang J, Zhang W, et al. Hematopoietic stem cell transplantation for acute myeloid leukemia: an overview of systematic reviews. Int J Clin Pract. 2022;2022:1828223. doi: https://doi.org/10.1155/2022/1828223 DOI: https://doi.org/10.1155/2022/1828223

Lamego RM, Clementino NCD, Costa ÂLB, et al. Transplante alogênico de células-tronco hematopoéticas em leucemias agudas: a experiência de dez anos do Hospital das Clínicas da UFMG. Rev Bras Hematol Hemoter. 2010;32(2):108-15. doi: https://doi.org/10.1590/S1516-84842010005000040 DOI: https://doi.org/10.1590/S1516-84842010005000040

Fleischhauer K, Tran TH, Meisel R, et al. Donor selection for allogeneic hematopoietic cell transplantation. Dtsch Arztebl Int. 2023;120(15):261-8. doi: https://doi.org/10.3238/arztebl.m2023.0031 DOI: https://doi.org/10.3238/arztebl.m2023.0031

Matias NMA. Leucemia linfoblástica aguda: fisiopatologia, diagnóstico e abordagens terapêuticas. [monografia]. Lisboa: Universidade de Lisboa, Faculdade de Farmácia; 2019. [acesso 2024 set 10]. Disponível em: https://repositorio.ul.pt/bitstream/10451/43361/1/MICF_Nidia_Matias.pdf.

Ministério da Saúde (BR). Ministério da Saúde. Portaria Conjunta nº 21, de 10 de dezembro de 2021. Aprova as Diretrizes Diagnósticas e Terapêuticas – Mesilato de Imatinibe no Tratamento da Leucemia Linfoblástica Aguda Cromossoma Philadelphia Positivo do Adulto. Diário Oficial da União, Brasília, DF. 10 dez 2021; Edição 234; Seção 1:111.

Archanjo LVF. Características e desfechos dos pacientes submetidos ao transplante de medula óssea admitidos na Unidade de Terapia Intensiva [dissertação]. São Paulo: Fundação Antônio Prudente; 2021. [acesso 2024 set 10]. Disponível em: https://docs.bvsalud.org/biblioref/2021/12/1348899/leticia-vicentin-finencio-archanjo.pdf.

Kiong LA, Hanna FSA, Souza GL, et al. Preditores de óbito em pacientes transplantados de medula óssea de um centro de referência na Amazônia brasileira. Rev HUGV. 2022;21:10780. doi: https://doi.org/10.60104/revhugv10780 DOI: https://doi.org/10.60104/revhugv10780

Hoff PMG, editor. Tratado de oncologia. São Paulo: Atheneu; 2013. 2829 p.

Evseeva I, Foeken L, Madrigal A. The role of unrelated donor registries in HSCT. In: Carreras E, Dufour C, Mohty M, et al., editores. The EBMT handbook: hematopoietic stem cell transplantation and cellular therapies [Internet]. 7 ed. Cham: Springer International Publishing; 2019. p. 19-25.[acesso 2023 dez 20]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK553967/ DOI: https://doi.org/10.1007/978-3-030-02278-5_3

REDOME [Internet]. Rio de Janeiro: INCA; [sem data]. Registro Brasileiro de Doadores Voluntários de Medula Óssea. [acesso 2023 dez 20]. Disponível em: https://redome.inca.gov.br/.

Ministério da Saúde (BR). Portaria n.º 931, de 29 de outubro de 2009. Estabelece regras para aprimorar a aplicação dos recursos disponíveis e a atualização do cadastro nacional de doadores, tornando o INCA. Diário Oficial da União, Brasília, DF, 30 out. 2009; Seção1.

Ministério da Saúde (BR), Instituto Nacional de Câncer José Alencar Gomes da Silva. Tópicos em transplante de células-tronco hematopoéticas. Rio de Janeiro: INCA; 2012. [acesso 2024 ago 3]. 192 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/topicos_transplante_ celtronco_hematopoeticas.pdf.

Batistiolle JV. Acesso aos transplantes de medula óssea no Brasil: uma questão de justiça. [dissertação]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 2014.[Acesso 2023 maio 10]. Disponível em: https://www.arca.fiocruz.br/bitstream/handle/icict/13140/195. pdf?sequence=1&isAllowed=y.

Hong S, Majhail NS. Aumento do acesso a aloenxertos nos Estados Unidos: o impacto de raça, geografia e fatores socioeconômicos. Hematology Am Soc Hematol Educ Program. 2021;2021(1):275-280. doi : https://doi.org/10.1182/hematology.2021000259 DOI: https://doi.org/10.1182/hematology.2021000259

Majhail NS, Omondi NA, Denzen E, et al. Access to hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant. 2010;16(8):1070-75. doi: https://doi.org/10.1016/j.bbmt.2009.12.529 DOI: https://doi.org/10.1016/j.bbmt.2009.12.529

Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples). Biometrika. 1965;52(3-4):591-611. DOI: https://doi.org/10.1093/biomet/52.3-4.591

Levene H. Robust test for equality of variances. In: Olkin I, editor. Contributions to probability and statistics: essays in honor of Harold Hotelling. Stanford: Stanford University Press; 1960. p. 278-92.

Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis. J Am Stat Assoc. 1952;47(260):583-621. doi: https://doi.org/10.1080/01621459.1952.10483441 DOI: https://doi.org/10.1080/01621459.1952.10483441

Hart A. Mann-Whitney test is not just a test of medians: differences in spread can be important. BMJ. 2001;323(7309):391-3. DOI: https://doi.org/10.1136/bmj.323.7309.391

Bonferroni CE. Teoria statistica delle classi e calcolo delle probabilità. Pubblicazioni del R Istituto Superiore di Scienze Economiche e Commerciali di Firenze. 1936;8:1-62.

Center for Humans and Machines, Max Planck Institute for Human Development, Berlin, Germany. Visualizations with statistical details: The ‘ggstatsplot’ approach.J Open Source Softw. 2021;6(61):3167. doi: https://doi.org/10.21105/joss.03167 DOI: https://doi.org/10.21105/joss.03167

Sjoberg DD, Whiting K, Curry M. Reproducible summary tables with the gtsummary Package. R J. 2021;13(1):570-

doi: https://doi.org/10.32614/RJ-2021-053 DOI: https://doi.org/10.32614/RJ-2021-053

R: The R Project for Statistical Computing [Internet]. Version 4.1.2 [place unknown]: The R foundation. 2021 Nov 2 - [acesso 2022 ago 6]. Disponível em: https://www.r-project.org/

Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.

Secretaria Estadual de Transplantes (PR) [Internet]. Curitiba: Secretaria de Saúde; [sem data]. [acesso 2023 dez 20]. Disponível em: https://www.paranatransplantes.pr.gov.br/

Majhail NS, Nayyar S, Santibañez ME, et al. Racial disparities in hematopoietic cell transplantation in the United States. Bone Marrow Transplant. 2012;47(11):1385-90. doi: https://doi.org/10.1038/bmt.2011.214 DOI: https://doi.org/10.1038/bmt.2011.214

Instituto Brasileiro de Geografia e Estatística. PNAD Contínua - pesquisa nacional por amostra de domicílios contínua: características gerais dos domicílios e dos moradores, 2022. Rio de Janeiro: IBGE; 2022.

Flannelly C, Tan BE, Tan JL, et al. Barriers to hematopoietic cell transplantation for adults in the United States: a systematic review with a focus on age. Biol Blood Marrow Transplant. 2020;26(12):2335-45. doi: https://doi.org/10.1016/j.bbmt.2020.09.013 DOI: https://doi.org/10.1016/j.bbmt.2020.09.013

Zioldo RR, Gimenes RO, Júnior CC. A importância da saúde suplementar na demanda da prestação dos serviços assistenciais no Brasil. Mundo saúde [Internet]. 2013 [acesso 2024 jun 25];37(2):216-21. Disponível em: https://bvsms.saude.gov.br/bvs/artigos/mundo_saude/importancia_ saude_suplementar_demanda_prestacao.pdf DOI: https://doi.org/10.15343/0104-7809.2013372216220

Silva TS, Horvath JDC, Pereira MP, et al. Impacto do tempo na lista de espera na sobrevida pós-TCTH: um estudo de coorte em um hospital do sul do Brasil. Hematol Transfus Cell Ther. 2023;46(3):242-9. doi: https://doi.org/10.1016/j.htct.2023.03.021 DOI: https://doi.org/10.1016/j.htct.2023.03.021

Zago MA, Falcão RP, Pasquini R. Tratado de hematologia. 1. ed. São Paulo: Editora Atheneu; 2013.

Pidala JA, Hamilton BK, Martin PJ, et al. The chronic graft-versus-host disease failure-free survival (cGVHD-FFS) index. Biol Blood Marrow Transplant. 2019;25(12):2468-73. doi: https://www.doi.org/10.1016/j.bbmt.2019.07.040 DOI: https://doi.org/10.1016/j.bbmt.2019.07.040

Dehn J, Chitphakdithai P, Show BE, et al. Likelihood of proceeding to allogeneic hematopoietic cell transplantation in the United States after search activation in the National Registry: impact of patient age, disease, and search prognosis. Transplant Cell Ther. 2021;27(2):184.e1-13. doi: https://doi.org/10.1016/j.bbmt.2020.10.004 DOI: https://doi.org/10.1016/j.bbmt.2020.10.004

Farhadfar N, Weaver MT, Al-Mansour Z, et al. Self-efficacy for symptom management in long-term adult hematopoietic stem cell survivors. Transplant Cell Ther. 2022;28(9):606.e1-8. doi: https://doi.org/10.1016%2Fj.jtct.2022.05.035 DOI: https://doi.org/10.1016/j.jtct.2022.05.035

Almeida GG, Cardoso LF, Paiva CRC, et al. Transplante de medula óssea no Brasil: distribuição e perfil de doadores cadastrados entre 2015 e 2022. Hematol Transfus Cell Ther. 2022;44(Supl 2). doi: https://doi.org/10.1016/j.htct.2022.09.555 DOI: https://doi.org/10.1016/j.htct.2022.09.555

Published

2024-11-29

How to Cite

1.
Miguel W de M, Adão CAE, Paulista JS, Amenu B. Analysis of Distribution and Access Time to Transplant in Patients with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia in Brazil (2016-2022). Rev. Bras. Cancerol. [Internet]. 2024 Nov. 29 [cited 2024 Dec. 4];70(4):e-054749. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/4749

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ORIGINAL ARTICLE