title: Relationship of race/ethnicity and survival after single umbilical cord blood transplantation for adults and children with leukemia and myelodysplastic syndromes.
abstract: The relationship of race/ethnicity with outcomes of umbilical cord blood transplantation (UCBT) is not well known. We analyzed the association between race/ethnicity and outcomes of unrelated single UCBT for leukemia and myelodysplastic syndromes. Our retrospective cohort study consisted of 885 adults and children (612 whites, 145 blacks, and 128 Hispanics) who received unrelated single UCBT for leukemia and myelodysplastic syndromes between 1995 and 2006 and were reported to the Center for International Blood and Marrow Transplant Research. A 5-6/6 HLA-matched unit with a total nucleated cell count infused of ≥2.5 × 10(7)/kg was given to 40% white and 42% Hispanic, but only 21% black patients. Overall survival at 2 years was 44% for whites, 34% for blacks, and 46% for Hispanics (P = .008). In multivariate analysis adjusting for patient, disease, and treatment factors (including HLA match and cell dose), blacks had inferior overall survival (relative risk of death, 1.31; P = .02), whereas overall survival of Hispanics was similar (relative risk, 1.03; P = .81) to that of whites. For all patients, younger age, early-stage disease, use of units with higher cell dose, and performance status ≥80 were independent predictors of improved survival. Black patients and white patients infused with well-matched cords had comparable survival; similarly, black and white patients receiving units with adequate cell dose had similar survival. These results suggest that blacks have inferior survival to whites after single UCBT, but outcomes are improved when units with a higher cell dose are used.
authors: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA. kballen@partners.org
authors: Karen K
authors: KK
authors: Ballen
authors: John P
authors: JP
authors: Klein
authors: Tanya L
authors: TL
authors: Pedersen
authors: Deepika
authors: D
authors: Bhatla
authors: Reggie
authors: R
authors: Duerst
authors: Joanne
authors: J
authors: Kurtzberg
authors: Hillard M
authors: HM
authors: Lazarus
authors: Charles F
authors: CF
authors: LeMaistre
authors: Phillip
authors: P
authors: McCarthy
authors: Paulette
authors: P
authors: Mehta
authors: Jeanne
authors: J
authors: Palmer
authors: Michelle
authors: M
authors: Setterholm
authors: John R
authors: JR
authors: Wingard
authors: Steven
authors: S
authors: Joffe
authors: Susan K
authors: SK
authors: Parsons
authors: Galen E
authors: GE
authors: Switzer
authors: Stephanie J
authors: SJ
authors: Lee
authors: J Douglas
authors: JD
authors: Rizzo
authors: Navneet S
authors: NS
authors: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D044383:Black People; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000276:immunology / Q000637:transplantation*; D006680:HLA Antigens / Q000276:immunology; D006630:Hispanic or Latino; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000208:ethnology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000208:ethnology* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D006680:HLA Antigens