Trends in survival rates after allogeneic hematopoietic stem-cell transplantation for acute and chronic leukemia by ethnicity in the United States and Canada.
OBJECTIVE
Differences in survival among ethnic groups in the United States are reported in numerous diseases and treatment strategies. Whether survival after allogeneic hematopoietic stem-cell transplantation (HSCT) differs by ethnicity is uncertain.


METHODS
Patients (n = 6443) receiving HLA-identical sibling HSCT for acute or chronic leukemia in the United States or Canada between 1985 and 1999 and reported to the International Bone Marrow Transplant Registry were included. The survival of recipients reported as white, black, Hispanic, or Asian was compared using Cox proportional hazards regression adjusting for other clinical factors. Three 5-year periods were studied to evaluate changes over time.


RESULTS
Hispanics compared with whites had lower 1-year (53% v 65%; P <.001) and 3-year adjusted survival rates (38% v 53%; P <.001) between 1995 and 1999, the most recent period studied. We failed to find significant differences in survival rates comparing whites with blacks or with Asians in any of the time periods. Overall survival for the entire cohort improved over time, from 56% to 63% at 1 year and from 43% to 51% at 3 years, with greater improvements noted among blacks (45% to 61% at 1 year and 34% to 48% at 3 years).


CONCLUSIONS
Disparities remain in survival rates between whites and Hispanics despite adjustment for clinical factors. Factors not accounted for in this analysis, such as comorbid disease, socioeconomic status, healthcare access and delivery, and psychosocial and cultural variables, require further prospective study.
Serna
Derek S
DS
Department of Internal Medicine, Health Policy Institute, Medical College of Wisconsin Milwaukee, WI 53226, USA.
Lee
Stephanie J
SJ
Zhang
Mei-jie
MJ
Baker
k Scott
kS
Eapen
Mary
M
Horowitz
Mary M
MM
Klein
John P
JP
Rizzo
J Douglas
JD
Loberiza
Fausto R
FR
D000208:Acute Disease; D000328:Adult; D001741:Black or African American; D002170:Canada; D002908:Chronic Disease; D005006:Ethnicity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006630:Hispanic or Latino; D006801:Humans; D007938:Leukemia / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy*; D008297:Male; D015996:Survival Rate; D013997:Time Factors; D014481:United States; D044465:White People