title: Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities.
abstract: Allogeneic transplant access can be severely limited for patients of racial and ethnic minorities without suitable sibling donors. Whether cord blood (CB) transplantation can extend transplant access because of the reduced stringency of required HLA-match is not proven. We prospectively evaluated availability of unrelated donors (URD) and CB according to patient ancestry in 553 patients without suitable sibling donors. URDs had priority if adequate donors were available. Otherwise ≥4/6 HLA-matched CB grafts were chosen utilizing double units to augment graft dose. Patients had highly diverse ancestries including 35% non-Europeans. In 525 patients undergoing combined searches, 10/10 HLA-matched URDs were identified in 53% of those with European ancestry, but only 21% of patients with non-European origins (P < .001). However, the majority of both groups had 5-6/6 CB units. The 269 URD transplant recipients were predominantly European, with non-European patients accounting for only 23%. By contrast, 56% of CB transplant recipients had non-European ancestries (P < .001). Of 26 patients without any suitable stem cell source, 73% had non-European ancestries (P < .001). Their median weight was significantly higher than CB transplant recipients (P <.001), partially accounting for their lack of a CB graft. Availability of CB significantly extends allo-transplant access, especially in non-European patients, and has the greatest potential to provide a suitable stem cell source regardless of race or ethnicity. Minority patients in need of allografts, but without suitable matched sibling donors, should be referred for combined URD and CB searches to optimize transplant access.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. barkerj@mskcc.org
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Byam
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Sinda S
authors.initials: SS
authors.lastname: Lee
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hawke
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Doshi
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Wells
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Esperanza B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: James W
authors.initials: JW
authors.lastname: Young
authors.forename: Marcel R M
authors.initials: MR
authors.lastname: van den Brink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001854:Bone Marrow Cells / Q000166:cytology; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000706:statistics & numerical data*; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data*; D005312:Fetal Blood / Q000166:cytology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data*; D006412:Hematopoietic Stem Cells / Q000166:cytology; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D019520:Living Donors / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009519:New York City; D044469:Racial Groups / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D055815:Young Adult
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