Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites

Abstract

The impact of race on outcome has been identified in a number of cancers, with African Americans having poorer survival compared with whites. We conducted a study to investigate the association of race with allogeneic hematopoietic cell transplant (HCT) outcomes. We identified 789 patients (58 African Americans and 731 whites) who underwent allogeneic HCT for hematologic disorders. There were no significant differences between African Americans and white patients in gender, performance status or comorbidity score. However, African Americans were younger than whites (median 40 years versus 47 years, P = 0.003) and were more likely to be in remission at HCT (74% versus 57%, P = 0.011), to have an HLA-mismatched donor (36% versus 14%, P o 0.001), to have positive donor or recipient CMV serostatus (90% versus 69%, P o 0.001) and to have received a cord blood transplant (21% versus 6%, Po 0.001). In univariate analysis, African Americans had worse overall survival (OS) (HR 1.41, P = 0.026) compared with whites, with no significant differences in acute or chronic GvHD, non-CMV infection or relapse. However, after adjusting for several transplant and disease-related factors in multivariate analysis, the OS difference between African Americans and whites became nonsignificant (HR 1.27, P = 0.18). These results suggest that race in and of itself does not lead to worse survival post HCT.

Sarcopenia and low muscle radiodensity associate with impaired FEV1 in allogeneic haematopoietic stem cell transplant recipients

“…COPD defined through spirometry was included in predictive models for FEV1 as a co‐morbidity that is generally mild in this population and thus is not comprehensively captured by the HCT‐CI. Ethnicity/race was not evaluated as it has not been shown to impact alloHCT outcomes to this point in US‐based populations 29 . Analyses were completed using IBM SPSS Statistics for Windows version 23.0 (SPSS, Chicago, IL), and results were considered significant at the P < 0.05 level.…”

“…Ethnicity/race was not evaluated as it has not been shown to impact alloHCT outcomes to this point in US-based populations. 29 Analyses were completed using IBM SPSS Statistics for Windows version 23.0 (SPSS, Chicago, IL), and results were considered significant at the P < 0.05 level.…”

Race and socioeconomic status in pediatric allogeneic hematopoietic cell transplantation for nonmalignant conditions

“…While the collection of data from only a single institution limits our sample size and may limit generalizability of findings, it also eliminates center variation as a possible source of confounding. This is relevant when considering that two multicenter studies of racial disparities in adult HCT found differences in survival by race, 18,20 but two single‐center studies did not 21,22 . Given the lack of published data regarding pediatric HCT outcomes by race and SES, our findings necessarily require validation and further study.…”

“…In contrast, two subsequent studies reported worse OS in black patients undergoing HCT, but no differences between Hispanic and white patients 19,20 . More recently, two single‐center studies published in 2015 observed no differences in survival after HCT based on race or ethnicity 21,22 . Results from studies investigating the impact of SES on outcomes in adult HCT are also inconsistent.…”

Inclusion of special populations in clinical research: important considerations and guidelines

“…Race and ethnicity have been linked to differences in genetic predispositions to disease [8][9][10][11]. Now that targeted therapies and personalized approaches to diseases having gene-based variances have become more available, genomically-informed approaches are increasingly important among special populations [12][13][14][15].…”