Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities.
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.
Barker
Juliet N
JN
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. barkerj@mskcc.org
Byam
Courtney E
CE
Kernan
Nancy A
NA
Lee
Sinda S
SS
Hawke
Rebecca M
RM
Doshi
Kathleen A
KA
Wells
Deborah S
DS
Heller
Glenn
G
Papadopoulos
Esperanza B
EB
Scaradavou
Andromachi
A
Young
James W
JW
van den Brink
Marcel R M
MR
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
Haematologica. 2009 Apr;94(4):536-41
19229051
Blood. 2007 Oct 15;110(8):3064-70
17569820
Blood. 2005 Feb 1;105(3):1343-7
15466923
Blood. 2008 Nov 15;112(10):4318-27
18723429
Hum Immunol. 2000 Aug;61(8):834-40
10980395
Haematologica. 2009 Apr;94(4):451-4
19336748
Biol Blood Marrow Transplant. 2009 Dec;15(12):1596-602
19896084
Blood. 2002 Sep 1;100(5):1611-8
12176879
N Engl J Med. 1989 Oct 26;321(17):1174-8
2571931
Hum Immunol. 2007 Jan;68(1):30-40
17207710
Blood. 2007 Dec 15;110(13):4576-83
17785583
J Clin Oncol. 2009 Jan 10;27(2):256-63
19064984
N Engl J Med. 2006 Apr 27;354(17):1813-26
16641398
Cancer. 2001 Jan 1;91(1 Suppl):274-8
11148593
Transplantation. 2004 Jul 15;78(1):89-95
15257044
Biol Blood Marrow Transplant. 2002;8(5):257-60
12064362
Blood. 2004 Oct 1;104(7):1923-30
15191952
N Engl J Med. 1998 Nov 26;339(22):1565-77
9828244
Transplantation. 1997 Oct 15;64(7):1017-27
9381524
Biol Blood Marrow Transplant. 2008 Dec;14(12):1334-40
19041054
N Engl J Med. 1996 Jul 18;335(3):157-66
8657213
Blood. 2009 Nov 5;114(19):4293-9
19706886
Bone Marrow Transplant. 2008 Aug;42 Suppl 1:S3-S5
18724295
Transplantation. 1995 Oct 27;60(8):778-83
7482734
Lancet. 2007 Jun 9;369(9577):1947-54
17560447
Blood. 1993 Apr 1;81(7):1679-90
8096404
Blood. 1996 Aug 1;88(3):795-802
8704232
Tissue Antigens. 2009 Jan;73(1):17-32
19000140
N Engl J Med. 1997 Aug 7;337(6):373-81
9241126
Transfusion. 2005 Jun;45(6):842-55
15934981