Access to hematopoietic stem cell transplantation: effect of race and sex.
BACKGROUND
The purpose of the current study was to determine whether the use of hematopoietic stem cell transplantation (HCT) to treat leukemia, lymphoma, or multiple myeloma (MM) differs by race and sex.


METHODS
The annual incidence of leukemia, lymphoma, and MM was estimated in the United States in people aged <70 years by race and sex using the Surveillance, Epidemiology, and End Results (SEER) cancer registry between 1997 and 2002 and US census reports for the year 2000. The annual incidence of autologous, human leukocyte antigen (HLA) identical sibling, and unrelated HCT performed in these groups was estimated using Center for International Blood and Marrow Transplant Research data from 1997 through 2002. Logistic regression analysis was used to calculate the age-adjusted odds ratio (OR) of receiving HCT for Caucasians versus African Americans and for men versus women.


RESULTS
The likelihood of undergoing HCT was found to be higher for Caucasians than for African Americans (OR, 1.40; 95% confidence interval [95% CI], 1.34-1.46). This difference existed for each type of HCT: autologous (OR, 1.24; 95% CI, 1.19-1.30), HLA identical sibling (OR, 1.59; 95% CI, 1.46-1.74), and unrelated donor (OR, 2.02; 95% CI, 1.75-2.33). Overall, men were more likely than women to receive HCT (OR, 1.07; 95% CI, 1.05-1.1 [P<.0001]); however, this difference was found to be significant only for autologous HCT (OR, 1.10; 95% CI, 1.07-1.13 [P<.0001]).


CONCLUSIONS
HCT is more frequently used to treat leukemia, lymphoma, and MM in Caucasians than in African American individuals. African Americans have lower rates of both autologous and allogeneic HCT, indicating that donor availability cannot fully explain the differences. Women are less likely than men to receive autologous HCT for reasons unexplained by age or disease status.
Joshua
Thomas V
TV
Center for Nursing Research, School of Nursing, Medical College of Georgia, Augusta, Georgia 30912, USA. tjoshua@mcg.edu
Rizzo
J Douglas
JD
Zhang
Mei-Jie
MJ
Hari
Parameswaran N
PN
Kurian
Seira
S
Pasquini
Marcelo
M
Majhail
Navneet S
NS
Lee
Stephanie J
SJ
Horowitz
Mary M
MM
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000208:ethnology / Q000628:therapy*; D008223:Lymphoma / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D044469:Racial Groups; D012737:Sex Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014481:United States; D044465:White People