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Background The purpose of this study was to determine whether utilization of Hematopoietic Stem Cell Transplantation (HCT) to treat leukemia, lymphoma or multiple myeloma differs by race and gender. Methods We estimated the annual incidence of leukemia, lymphoma and multiple myeloma in the United States (US) in people younger than 70 years by race and gender using the SEER Cancer Registry between 1997 and 2002 and US Census Reports for year 2000. The annual incidence of autologous, human leukocyte antigen (HLA) identical sibling and unrelated HCT performed in these groups in the US was estimated using Center for International Blood and Marrow Transplant Research data from 1997 to 2002. Logistic regression was used to calculate the age-adjusted odds ratio of receiving HCT for Caucasians versus African-Americans and men versus women. Results The likelihood of undergoing HCT was higher for Caucasians than for African-Americans [Odds Ratio (OR) =1.40 (95%CI: 1.34-1.46)]. This difference existed for each type of HCT: autologous [OR=1.24 (1.19-1.30)], HLA identical sibling [OR=1.59 (1.46-1.74)] and unrelated donor [OR=2.02 (1.75-2.33)]. Overall, men were more likely than women to receive HCT [OR=1.07 (1.05-1.1) p<0.0001]; however, this difference was significant only for autologous HCT [OR=1.10 (1.07-1.13), p<0.0001]. Conclusions HCT is more frequently used to treat leukemia, lymphoma and multiple myeloma in Caucasians than in African-Americans. African-Americans have lower rates of both autologous and allogeneic HCT, indicating that donor availability cannot fully explain the differences. Women are less likely than men to receive autologous HCT for reasons unexplained by age or disease status.

Purpose To examine the independent roles of pre–hematopoietic cell transplantation (HCT) therapeutic exposures, transplantation-related conditioning, and comorbidities (pre- and post-HCT) in the development of late congestive heart failure (CHF) after HCT. Methods This was a nested case-control design. Individuals with late CHF (diagnosed ≥ 1 year after HCT) were identified from a cohort of 2,938 1+ year survivors who underwent transplantation at City of Hope National Medical Center, Duarte, CA. This cohort formed the sampling frame for selecting controls (without CHF) matched for age and year of HCT, donor source (allogeneic v autologous), and length of follow-up. Results Sixty patients with late CHF were identified; median age at HCT was 45.3 years (range, 16.6 to 68.6 years); median time to CHF was 3.0 years (range, 1.03 to 18.9 years); 68% received autologous HCT. Median ejection fraction was 36.9% (range, 15% to 53%). Compared with matched controls (n = 166), patients with late CHF received more cycles of pre-HCT chemotherapy (8.6 v 4.9 cycles; P < .01), had greater body mass index at HCT (28.4 v 26.2 kg/m2; P = .01), greater lifetime anthracycline exposure (285.3 v 175.6 mg/m2; P < .01), and were more likely to have multiple chronic comorbidities (30.0% v 13.9%; P < .01). Multivariable analysis revealed number of pre-HCT chemotherapy cycles (odds ratio [OR] = 1.2; P < .01), anthracycline dose ≥ 250 mg/m2 (OR = 3.2; P = .05), and two or more chronic comorbidities (OR = 4.3; P = .01) to be independently associated with late CHF. Conclusion Pre-HCT exposure to anthracyclines and presence of comorbidities are primarily responsible for the risk associated with late CHF after HCT. Conditioning-related therapeutic exposure does not contribute significantly to the risk. These results form the basis for identifying high-risk individuals for targeted surveillance, as well as developing preventive strategies in the form of aggressive management of comorbidities.

We report outcomes after unrelated donor hematopoietic cell transplantation (HCT) for 91 patients with hemophagocytic lymphohistiocytosis (HLH) transplanted in the US in 1989-2005. Fifty-one percent were o1 year at HCT and 29% had Lansky performance scores o90%. Most (80%) were conditioned with BU, CY, and etoposide (VP16) with or without anti-thymocyte globulin. Bone marrow was the predominant graft source. Neutrophil recovery was 91% at day-42. The probabilities of grades 2-4 acute GVHD at day-100 and chronic GVHD at 5 years were 41 and 23%, respectively. The overall mortality rate was higher in patients who did not receive BU/CY/VP16-conditioning regimen (RR 1.95, P ¼ 0.035). The 5-year probability of overall survival was 53% in patients who received BU/CY/VP16 compared to 24% in those who received other regimens. In the subset of patients with known disease-specific characteristics, only one of five patients with active disease at HCT is alive. For those in clinical remission at HCT (n ¼ 46), the 5-year probability of overall survival was 49%. Early mortality rates after HCT were high, 35% at day-100. These data demonstrate that a BU/CY/VP16-conditioning regimen provides cure in approximately 50% of patients and future studies should explore strategies to lower early mortality.