Comparison of graft-versus-host-disease and survival after HLA-identical sibling bone marrow transplantation in ethnic populations.
The association of ethnicity with the incidence of graft-versus-host disease (GVHD) and other clinical outcomes after transplantation is controversial. We compared the results of HLA-identical sibling bone marrow transplantations for leukemia, performed between 1990 and 1999, among different ethnic populations, including 562 Japanese, 829 white Americans, 71 African Americans, 195 Scandinavians, and 95 Irish. Results for adults and children were analyzed separately. Multivariate analyses of adult patients showed that white Americans, African Americans, and Irish cohorts were at significantly higher risk for acute GVHD than Japanese or Scandinavian cohorts (relative risk [RR] = 1.77, P < .001; RR = 1.84, P < .006; RR = 2.22, P < .001, respectively). White Americans, African Americans, and Irish, but not Scandinavians, were at significantly higher risk for early (within 3 months of transplantation) transplant-related mortality (TRM) compared with Japanese (RR = 2.99, P < .001; RR = 5.88, P < .001; RR = 2.66, P < .009, respectively). No differences in the risk for chronic GVHD, relapse, and overall survival were noted. In the pediatric cohort (limited to Japanese and white Americans), white Americans were at significantly higher risk for acute (RR = 1.93; P = .04) and chronic (RR = 3.16; P = .002) GVHD. No differences in other clinical outcomes were noted. Our findings suggest that ethnicity may influence the risk for GVHD, though overall survival rates after transplantation remain similar.
GVHD/Immune Reconstitution Wroking Committee of the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milaukee, WI, USA. hakumei@chive.ocn.ne.jp
Hakumei
H
Oh
Fausto R
FR
Loberiza
Mei-jie
MJ
Zhang
Olle
O
Ringdén
Hideki
H
Akiyama
Takayoshi
T
Asai
Shuichi
S
Miyawaki
Shinichiro
S
Okamoto
Mary M
MM
Horowitz
Joseph H
JH
Antin
Asad
A
Bashey
Jennifer M
JM
Bird
Matthew H
MH
Carabasi
Joseph W
JW
Fay
Robert Peter
RP
Gale
Roger H
RH
Giller
John M
JM
Goldman
Gregory A
GA
Hale
Richard E
RE
Harris
Jean
J
Henslee-Downey
Hans-Jochem
HJ
Kolb
Mark R
MR
Litzow
Philip L
PL
McCarthy
Steven M
SM
Neudorf
Derek S
DS
Serna
Gerard
G
Socié
Pierre
P
Tiberghien
A John
AJ
Barrett
D000328:Adult; D000367:Age Factors; D000483:Alleles; D016026:Bone Marrow Transplantation / Q000208:ethnology* / Q000276:immunology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005787:Gene Frequency; D006086:Graft vs Host Disease / Q000208:ethnology* / Q000235:genetics / Q000276:immunology / Q000401:mortality*; D006680:HLA Antigens / Q000032:analysis* / Q000235:genetics; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000209:etiology / Q000401:mortality; D008297:Male; D012008:Recurrence; D035781:Siblings; D016896:Treatment Outcome
D006680:HLA Antigens