Race and socioeconomic status influence outcomes of unrelated donor hematopoietic cell transplantation.

Baker KS, Davies SM, Majhail NS, Hassebroek A, Klein JP, Ballen KK, Bigelow CL, Frangoul HA, Hardy CL, Bredeson C, Dehn J, Friedman D, Hahn T, Hale G, Lazarus HM, LeMaistre CF, Loberiza F, Maharaj D, McCarthy P, Setterholm M, Spellman S, Trigg M, Maziarz RT, Switzer G, Lee SJ, Rizzo JD
Biol Blood Marrow Transplant. 2009 15 (12): 1543-54

PMID: 19896078 · PMCID: PMC2775819 · DOI:10.1016/j.bbmt.2009.07.023

Success of hematopoietic cell transplantation (HCT) can vary by race, but the impact of socioeconomic status (SES) is not known. To evaluate the role of race and SES, we studied 6207 unrelated-donor myeloablative (MA) HCT recipients transplanted between 1995 and 2004 for acute or chronic leukemia or myelodysplastic syndrome (MDS). Patients were reported by transplant center to be White (n = 5253), African American (n = 368), Asian/Pacific-Islander (n = 141), or Hispanic (n = 445). Patient income was estimated from residential zip code at time of HCT. Cox regression analysis adjusting for other significant factors showed that African American (but not Asian or Hispanic) recipients had worse overall survival (OS) (relative-risk [RR] 1.47; 95% confidence interval [CI] 1.29-1.68, P < .001) compared to Whites. Treatment-related mortality (TRM) was higher in African Americans (RR 1.56; 95% CI 1.34-1.83, P < .001) and in Hispanics (RR 1.30; 95% CI 1.11-1.51, P = .001). Across all racial groups, patients with median incomes in the lowest quartile (<$34,700) had worse OS (RR 1.15; 95% CI 1.04-1.26, P = .005) and higher risks of TRM (RR 1.21; 1.07-1.36, P = .002). Inferior outcomes among African Americans are not fully explained by transplant-related factors or SES. Potential other mechanisms such as genetic polymorphisms that have an impact on drug metabolism or unmeasured comorbidities, socioeconomic factors, and health behaviors may be important. Low SES, regardless of race, has a negative impact on unrelated donor HCT outcomes.

MeSH Terms (22)

Adolescent Adult Aged Child Child, Preschool Continental Population Groups Disease-Free Survival Female Health Status Disparities Hematopoietic Stem Cell Transplantation Humans Infant Male Middle Aged Multivariate Analysis Recurrence Retrospective Studies Social Class Tissue Donors Transplantation Conditioning Treatment Outcome Young Adult

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