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Histocompatibility and Donor Selection Issues

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

Bone Marrow Transplantation volume 50, pages 834–839 (2015)Cite this article

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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<0.001), to have positive donor or recipient CMV serostatus (90% versus 69%, P<0.001) and to have received a cord blood transplant (21% versus 6%, P<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.

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Acknowledgements

We thank the transplantation team at the Cleveland Clinic Taussig Cancer Institute for their contributions, and all our patients for their participation. We thank Navneet Majhail, MD, MS, for his constructive review of the manuscript.

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Authors and Affiliations

  1. Department of Hematologic Oncology and Blood Disorders, Bone Marrow Transplant Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    B K Hamilton, M Kalaycio, R Sobecks, R Dean, H Duong, B T Hill & B Bolwell

  2. Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA

    L Rybicki

  3. Department of Hematologic Oncology and Blood Disorders, Leukemia Program, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    M Sekeres

  4. Pediatric Hematology Oncology, Cleveland Clinic, Cleveland, OH, USA

    R Hanna

  5. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA

    E Copelan

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Correspondence to B K Hamilton.

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Hamilton, B., Rybicki, L., Sekeres, M. et al. Racial differences in allogeneic hematopoietic cell transplantation outcomes among African Americans and whites. Bone Marrow Transplant 50, 834–839 (2015). https://doi.org/10.1038/bmt.2015.44

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