Race and Socioeconomic Status Influence Outcomes of Unrelated Donor Hematopoietic Cell Transplantation

K. Scott Baker, Stella M. Davies, Navneet S. Majhail, Anna Hassebroek, John P. Klein, Karen K. Ballen, Carolyn L. Bigelow, Haydar A. Frangoul, Cheryl L. Hardy, Christopher Bredeson, Jason Dehn, Debra Friedman, Theresa Hahn, Gregory Hale, Hillard M. Lazarus, C. F. LeMaistre, Fausto Loberiza, Dipnarine Maharaj, Philip McCarthy, Michelle SetterholmStephen Spellman, Michael Trigg, Richard T. Maziarz, Galen Switzer, Stephanie J. Lee, J. Douglas Rizzo

Research output: Contribution to journalArticle

80 Scopus citations

Abstract

Success of hematopoietic cell transplantation (HCT) can vary by race, but the impact of socioeconomic status (SES) is not known. To evaluate the role of race and SES, we studied 6207 unrelated-donor myeloablative (MA) HCT recipients transplanted between 1995 and 2004 for acute or chronic leukemia or myelodysplastic syndrome (MDS). Patients were reported by transplant center to be White (n = 5253), African American (n = 368), Asian/Pacific-Islander (n = 141), or Hispanic (n = 445). Patient income was estimated from residential zip code at time of HCT. Cox regression analysis adjusting for other significant factors showed that African American (but not Asian or Hispanic) recipients had worse overall survival (OS) (relative-risk [RR] 1.47; 95% confidence interval [CI] 1.29-1.68, P < .001) compared to Whites. Treatment-related mortality (TRM) was higher in African Americans (RR 1.56; 95% CI 1.34-1.83, P < .001) and in Hispanics (RR 1.30; 95% CI 1.11-1.51, P = .001). Across all racial groups, patients with median incomes in the lowest quartile (<$34,700) had worse OS (RR 1.15; 95% CI 1.04-1.26, P = .005) and higher risks of TRM (RR 1.21; 1.07-1.36, P = .002). Inferior outcomes among African Americans are not fully explained by transplant-related factors or SES. Potential other mechanisms such as genetic polymorphisms that have an impact on drug metabolism or unmeasured comorbidities, socioeconomic factors, and health behaviors may be important. Low SES, regardless of race, has a negative impact on unrelated donor HCT outcomes.

Original languageEnglish (US)
Pages (from-to)1543-1554
Number of pages12
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2009

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Race
  • Socioeconomic status
  • Survival
  • Unrelated donor

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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  • Cite this

    Baker, K. S., Davies, S. M., Majhail, N. S., Hassebroek, A., Klein, J. P., Ballen, K. K., Bigelow, C. L., Frangoul, H. A., Hardy, C. L., Bredeson, C., Dehn, J., Friedman, D., Hahn, T., Hale, G., Lazarus, H. M., LeMaistre, C. F., Loberiza, F., Maharaj, D., McCarthy, P., ... Rizzo, J. D. (2009). Race and Socioeconomic Status Influence Outcomes of Unrelated Donor Hematopoietic Cell Transplantation. Biology of Blood and Marrow Transplantation, 15(12), 1543-1554. https://doi.org/10.1016/j.bbmt.2009.07.023