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

被引：126

作者：

Baker, K. Scott ^{[1
]}

Davies, Stella M. ^{[2
]}

Majhail, Navneet S. ^{[3
,4
]}

Hassebroek, Anna ^{[4
]}

Klein, John P. ^{[5
]}

Ballen, Karen K. ^{[6
]}

Bigelow, Carolyn L. ^{[7
]}

Frangoul, Haydar A. ^{[8
]}

Hardy, Cheryl L. ^{[7
]}

Bredeson, Christopher ^{[9
]}

Dehn, Jason ^{[10
]}

Friedman, Debra ^{[8
]}

Hahn, Theresa ^{[11
]}

Hale, Gregory ^{[12
]}

Lazarus, Hillard M. ^{[13
]}

LeMaistre, C. F. ^{[14
]}

Loberiza, Fausto ^{[15
]}

Maharaj, Dipnarine ^{[16
]}

McCarthy, Philip ^{[11
]}

Setterholm, Michelle ^{[10
]}

Spellman, Stephen ^{[10
]}

Trigg, Michael ^{[17
]}

Maziarz, Richard T. ^{[18
]}

Switzer, Galen ^{[19
]}

Lee, Stephanie J. ^{[1
]}

Rizzo, J. Douglas ^{[5
]}

机构：

[1] Fred Hutchinson Canc Res Ctr, Seattle, WA 98109 USA

[2] Cincinnati Childrens Hosp, Med Ctr, Cincinnati, OH USA

[3] Univ Minnesota, Minneapolis, MN USA

[4] Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA

[5] Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI USA

[6] Massachusetts Gen Hosp, Boston, MA 02114 USA

[7] Univ Mississippi, Med Ctr, Jackson, MS 39216 USA

[8] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[9] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[10] Natl Marrow Donor Program, Minneapolis, MN USA

[11] Roswell Pk Canc Inst, Buffalo, NY 14263 USA

[12] Univ S Florida, All Childrens Hosp, St Petersburg, FL 33701 USA

[13] Univ Hosp Case Med Ctr, Cleveland, OH USA

[14] Texas Transplant Inst, San Antonio, TX USA

[15] Univ Nebraska, Med Ctr, Omaha, NE USA

[16] S Florida Bone Marrow Stem Cell Transplant Inst, Boynton Beach, FL USA

[17] Merck & Co Inc, Wilmington, DE USA

[18] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[19] Univ Pittsburgh, Pittsburgh, PA USA

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2009年 / 15卷 / 12期

关键词：

Allogeneic hematopoietic cell transplantation; Unrelated donor; Race; Socioeconomic status; Survival; VERSUS-HOST-DISEASE; QUALITY-OF-CARE; RACIAL-DIFFERENCES; LIVER-TRANSPLANTATION; GENETIC-VARIATION; CHRONIC LEUKEMIA; HEALTH-CARE; SURVIVAL; BLACK; WHITE;

D O I：

10.1016/j.bbmt.2009.07.023

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 = 14 1), 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 [Cl] 1.29-1.68, P < .001) compared to Whites. Treatment-related mortality (TRM) was higher in African Americans (RR 1.56; 95% Cl 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% Cl 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. Biol Blood Marrow Transplant 15: 1543-1554 (2009) (C) 2009 American Society for Blood and Marrow Transplantation

引用

页码：1543 / 1554

页数：12

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