Outcomes of Hematopoietic Cell Transplantation in Ethnic and Racial Minorities

 

With the growing diversity in race and ethnicity of the American population, there is a need to characterize the disparities in access and outcomes of hematopoietic cell transplantation (HCT) for the racial and ethnic minorities. This single center study examined the association of ethnicity/ race with outcomes after HCT. Clinical information of 301 adult patients who underwent single allogeneic HCT for a hematological disorder at Mayo Clinic in Arizona from 11/03 to 06/12 was obtained from the institutional database and retrospective chart review. Information about ethnicity was self-reported by patients. Median follow-up was 20 months (range 3-106 months). Overall survival was compared between the racial/ ethnic groups using Cox regression while adjusting for other clinical factors. 

The study included 224 white patients (75%) and 77 ethnic minority patients (25%). Non-whites/ Hispanics were younger at HCT (median age 40 vs. 56, p=0.001). Use of myeloablative conditioning (61% vs. 31%, p<0.001) and related donors (50% vs. 35%, p=0.01) was more common in Non-whites/ Hispanics. There were no differences in disease diagnosis and risk, gender distribution and HCT- comorbidity index between the two groups. More Non-whites/Hispanics were unemployed (51% vs. 25%; p<0.001). No statistically significant differences in the incidence of post-transplant complications including infections, veno-occlusive disease, grade II-IV acute and NIH chronic GVHD were seen between the two groups. Cumulative incidence of relapse at 5 years was higher in Non-whites/ Hispanics (33% vs. 22%; p=0.03). Though the univariate analysis showed no differences in overall survival (5 year OS: 52% for Whites vs. 50% for Non-whites/Hispanics; p=0.44), a higher risk for mortality was seen in the multivariate analysis for ethnic minorities as compared to the white patients. (Table)

 Higher risk of mortality from HCT in the ethnic minorities underscores the need for better understanding of the factors responsible for differential outcomes and continued efforts to eliminate disparities in access and outcomes of HCT.