Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia and Related Hospital Outcomes: A Cross-Sectional Study of US Hospitals

Sravani Kommuru; Sowmya Sagireddy; Adit M Patel; Hruday Raj Thoutam; Saaniya Yasmeen; Amr A Jarrad; Gagan Kaur; Viralkumar Patel

doi:10.7759/cureus.32821

Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia and Related Hospital Outcomes: A Cross-Sectional Study of US Hospitals

Cureus. 2022 Dec 22;14(12):e32821. doi: 10.7759/cureus.32821. eCollection 2022 Dec.

Authors

Sravani Kommuru¹, Sowmya Sagireddy², Adit M Patel³, Hruday Raj Thoutam⁴, Saaniya Yasmeen⁵, Amr A Jarrad⁶, Gagan Kaur⁷, Viralkumar Patel⁸

Affiliations

¹ Internal Medicine, Dr.Pinnamaneni Siddhartha Institute of Medical Science and Research Foundation, Vijayawada, IND.
² Internal Medicine, Coney Island Hospital, New York, USA.
³ Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
⁴ Internal Medicine, Kakatiya Medical College, Warangal, IND.
⁵ Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND.
⁶ Internal Medicine, University of Jordan, Amman, JOR.
⁷ Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND.
⁸ Internal Medicine, Sarasota Memorial Hospital, Sarasota, USA.

Abstract

Background In this study, we aimed to provide a descriptive overview of the utilization of hematopoietic stem cell transplantation (HSCT) for the treatment of acute myeloid leukemia (AML), determine the rates of HSCT use stratified by patients' demographic characteristics, and measure the hospitalization outcomes. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS) obtained from hospitals in the United States. Our sample included 21,385 adult patients (aged ≥18 years) with a primary discharge diagnosis of AML. The sample was further grouped by inpatients who were managed with HSCT and chemotherapy as the primary procedure. We compared the demographic characteristics and hospital outcomes in AML inpatients across treatment cohorts by performing descriptive statistics and Pearson's chi-square test. Next, we measured the differences in continuous variables (length of stay and cost) using the analysis of variance (ANOVA). All analyses were conducted using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results The hospital-based utilization rate of HSCT was 0.4% in AML inpatients. The utilization rate of HSCT was higher in females (0.5%), African Americans (0.6%), those with median household incomes above the 50th percentile (0.5%), and those covered by private insurance (0.8%). A significantly higher proportion of AML inpatients with HSCT had depression (22.2% vs. 11.4% in total). AML inpatients receiving HSCT had significantly longer hospitalization stays and higher treatment costs than those receiving chemotherapy. The all-cause inpatient mortality was 11.6% in AML inpatients. Statistically, there were no significant differences by treatment. Conclusions HSCT appears to be underutilized for the treatment of AML. This treatment had a higher utilization rate in females and those from high-income families and was covered by private insurance. The utilization of chemotherapy and HSCT did not significantly differ in the presence of comorbidities, except for depression and hypertension having a higher utilization of HSCT.

Keywords: acute myeloid leukemia (aml); health services utilization; hematopoietic stem cell transplantation (hsct); hsct; in-hospital outcome; nationwide inpatient sample (nis).