title: Significance of ethnicity in the risk of acute graft-versus-host disease and leukemia relapse after unrelated donor hematopoietic stem cell transplantation.
abstract: The significance of patient and donor ethnicity on risk of acute graft-versus-host disease (GVHD) and disease relapse after unrelated donor hematopoietic cell transplantation (HCT) is not known. A total of 4335 patient-donor pairs from the International Histocompatibility Working Group in HCT met the following 3 criteria: (1) HLA-A, -B, -C, -DRB1, and -DQB1 allele matched donor, (2) diagnosis of leukemia, and (3) non-T cell depleted GVHD prophylaxis. Posttransplantation risks of acute GVHD and leukemia relapse were defined in Asian/Pacific Islander, white, African American, Hispanic, and Native American patients that underwent transplantation from donors with the same self-described background. Asian patients had a significantly lower incidence of acute GVHD (Japanese patients: 40.0% grades II to IV and 15.3% grades III to IV; non-Japanese Asian patients: 42.1% grades II to IV and 15.7% grades III to IV) compared with white patients (56.5% grades II to IV and 22.6% grades III to IV) (P < .001). The hazard ratio of acute GVHD for white patients was significantly higher than for Japanese patients. Unexpectedly, the hazard ratio of leukemia relapse in white patients with early disease status was also significantly higher than that in Japanese patients. These results provide a platform for future investigation into the genetic factors for unrelated donor HCT and clinical implications of diverse ethnic background.
authors.affiliation: Japan Marrow Donor Program, Tokyo, Japan; Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan. ymorisim@aichi-cc.jp
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawase
authors.forename: Mari
authors.initials: M
authors.lastname: Malkki
authors.forename: Satoko
authors.initials: S
authors.lastname: Morishima
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.forename: Koichi
authors.initials: K
authors.lastname: Kashiwase
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
authors.forename: Anne
authors.initials: A
authors.lastname: Cesbron
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tiercy
authors.forename: David
authors.initials: D
authors.lastname: Senitzer
authors.forename: Andrea
authors.initials: A
authors.lastname: Velardi
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
mesh_terms: D000208:Acute Disease; D000328:Adult; D000483:Alleles; D044466:Asian People; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D059866:HLA-DQ beta-Chains / Q000235:genetics / Q000276:immunology; D059811:HLA-DRB1 Chains / Q000235:genetics / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007938:Leukemia / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors; D044465:White People
chemical_list: D006680:HLA Antigens; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D059811:HLA-DRB1 Chains
keywords: Acute Graft-versus-host disease; Ethnicity; Leukemia relapse; Unrelated donor transplantation