title: Race/ethnicity affects the probability of finding an HLA-A, -B, -C and -DRB1 allele-matched unrelated donor and likelihood of subsequent transplant utilization.
abstract: Factors relevant to finding a suitable unrelated donor and barriers to effective transplant utilization are incompletely understood. Among a consecutive series of unrelated searches (n=531), an 8/8 HLA-A, -B, -C and -DRB1-matched unrelated donor was available for 289 (54%) patients, 7/8 for 159 (30%) and no donor for 83 (16%). Patients of Caucasian race (P<0.0001) were more likely to find a donor. Younger age (P=0.01), Caucasian race (P=0.03), lower CIBMTR (Center for International Blood and Marrow Transplantation Research) risk (P=0.005), and 8/8 HLA matching (P=0.005) were associated with higher odds of reaching hematopoietic cell transplantation (HCT). In a univariate analysis of OS, finding a donor was associated with hazard ratio (HR) of 0.85 (95% CI 0.63-1.2), P=0.31. Karnofsky performance status (KPS) accounted for interaction between having a donor and survival. Patients with KPS 90-100 and a donor had significantly reduced hazard for death (HR 0.59, 95% CI 0.38-0.90, P=0.02). These data provide estimates of the probability to find an unrelated donor in the era of high-resolution HLA typing, and identify potentially modifiable barriers to reaching HCT. Further efforts are needed to enhance effective donor identification and transplant utilization, particularly in non-Caucasian ethnic groups.
authors.affiliation: Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA. joseph.pidala@moffitt.org
authors.forename: J
authors.initials: J
authors.lastname: Pidala
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: M
authors.initials: M
authors.lastname: Schell
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
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authors.lastname: Hillgruber
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authors.lastname: Ayala
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authors.lastname: Alsina
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authors.lastname: Betts
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authors.lastname: Bookout
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authors.lastname: Fernandez
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authors.lastname: Field
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authors.lastname: Locke
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authors.lastname: Nishihori
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authors.lastname: Ochoa
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authors.lastname: Perez
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authors.lastname: Perkins
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authors.lastname: Shapiro
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authors.lastname: Tate
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authors.lastname: Tomblyn
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authors.lastname: Anasetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D005260:Female; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000208:ethnology* / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000235:genetics*; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens