Race and socioeconomic status influence outcomes of unrelated donor hematopoietic cell transplantation.
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.
Baker
K Scott
KS
Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. ksbaker@fhcrc.org
Davies
Stella M
SM
Majhail
Navneet S
NS
Hassebroek
Anna
A
Klein
John P
JP
Ballen
Karen K
KK
Bigelow
Carolyn L
CL
Frangoul
Haydar A
HA
Hardy
Cheryl L
CL
Bredeson
Christopher
C
Dehn
Jason
J
Friedman
Debra
D
Hahn
Theresa
T
Hale
Gregory
G
Lazarus
Hillard M
HM
LeMaistre
C F
CF
Loberiza
Fausto
F
Maharaj
Dipnarine
D
McCarthy
Philip
P
Setterholm
Michelle
M
Spellman
Stephen
S
Trigg
Michael
M
Maziarz
Richard T
RT
Switzer
Galen
G
Lee
Stephanie J
SJ
Rizzo
J Douglas
JD
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