Faculty Collaboration Database

Racial, ethnic, and socioeconomic diversity and outcomes of patients with graft-versus-host disease: a CIBMTR analysis. Blood Adv 2024 Sep 24;8(18):4963-4976

Date

05/22/2024

Pubmed ID

38776400

Pubmed Central ID

PMC11496972

DOI

10.1182/bloodadvances.2024013074

Scopus ID

2-s2.0-85204998500 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Socioeconomic status (SES) and race/ethnicity have been associated with the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HCT). Certain aspects of graft-versus-host disease (GVHD) management, such as the need for long-term care, prolonged immunosuppressive treatment, and close follow-up for complications, may exacerbate disparities. Adults (≥18 years) reported to the Center for International Blood and Marrow Transplant Research who underwent a first allo-HCT for acute leukemia, myelodysplastic syndrome, or myeloproliferative neoplasm between 2008 and 2018 were included. End points for those developing GVHD included overall survival (OS), transplant-related mortality (TRM), and disease relapse. Models were adjusted for patient- and transplant-related variables. A 2-sided P value < .01 was considered significant. Among the 14 825 allo-HCT recipients, 6259 (42.2%) and 6675 (45.0%) patients developed acute GVHD (aGVHD) and chronic GVHD (cGVHD), respectively. Among patients with aGVHD, non-Hispanic Black patients had increased TRM and overall mortality compared with non-Hispanic White patients; this association disappeared when severity of aGVHD was included in the model. Lower SES was associated with increased risk of disease relapse but not OS or TRM. In patients who developed cGVHD, race and ethnicity were not associated with OS, TRM, or disease relapse. However, the highest quartile of annual household income (≥$80 000) had improved OS and reduced TRM compared with the lowest quartile, after adjusting for race and ethnicity. In summary, race/ethnicity and SES are associated with outcomes after GVHD. Optimizing the health care resources available to low SES patients and strategies to minimize the risk of severe GVHD in non-Hispanic Black patients may improve long-term outcomes.

Author List

Farhadfar N, Rashid N, Chen K, DeVos J, Wang T, Ballen K, Beitinjaneh A, Bhatt VR, Hamilton BK, Hematti P, Gadalla SM, Solomon SR, El Jurdi N, Lee CJ, MacMillan ML, Rangarajan HG, Schoemans H, Sharma A, Spellman SR, Wingard JR, Lee SJ

Authors

Jakob D. Devos Biostatistician I in the Center for International Blood and Marrow Transplant Research department at Medical College of Wisconsin
Peiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Tao Wang PhD Professor in the Data Science Institute department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Socioeconomic Factors
Transplantation, Homologous
Treatment Outcome
Young Adult