title: Race and socioeconomic status influence outcomes of unrelated donor hematopoietic cell transplantation.
abstract: 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.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. ksbaker@fhcrc.org
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.forename: Anna
authors.initials: A
authors.lastname: Hassebroek
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Bigelow
authors.forename: Haydar A
authors.initials: HA
authors.lastname: Frangoul
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Hardy
authors.forename: Christopher
authors.initials: C
authors.lastname: Bredeson
authors.forename: Jason
authors.initials: J
authors.lastname: Dehn
authors.forename: Debra
authors.initials: D
authors.lastname: Friedman
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: C F
authors.initials: CF
authors.lastname: LeMaistre
authors.forename: Fausto
authors.initials: F
authors.lastname: Loberiza
authors.forename: Dipnarine
authors.initials: D
authors.lastname: Maharaj
authors.forename: Philip
authors.initials: P
authors.lastname: McCarthy
authors.forename: Michelle
authors.initials: M
authors.lastname: Setterholm
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.forename: Michael
authors.initials: M
authors.lastname: Trigg
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Galen
authors.initials: G
authors.lastname: Switzer
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D054624:Health Status Disparities; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000208:ethnology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012008:Recurrence; D012189:Retrospective Studies; D012923:Social Class; D014019:Tissue Donors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult