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

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...

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Bibliographic Details
Published in:Biology of blood and marrow transplantation 2009-12, Vol.15 (12), p.1543-1554
Main Authors: Baker, K. Scott, Davies, Stella M, Majhail, Navneet S, Hassebroek, Anna, Klein, John P, Ballen, Karen K, Bigelow, Carolyn L, Frangoul, Haydar A, Hardy, Cheryl L, Bredeson, Christopher, Dehn, Jason, Friedman, Debra, Hahn, Theresa, Hale, Gregory, Lazarus, Hillard M, LeMaistre, C.F, Loberiza, Fausto, Maharaj, Dipnarine, McCarthy, Philip, Setterholm, Michelle, Spellman, Stephen, Trigg, Michael, Maziarz, Richard T, Switzer, Galen, Lee, Stephanie J, Rizzo, J. Douglas
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Allogeneic hematopoietic cell transplantation
Child
Child, Preschool
Continental Population Groups
Disease-Free Survival
Female
Health Status Disparities
Hematology, Oncology and Palliative Medicine
Hematopoietic Stem Cell Transplantation - economics
Hematopoietic Stem Cell Transplantation - ethnology
Humans
Infant
Male
Middle Aged
Multivariate Analysis
Race
Recurrence
Retrospective Studies
Social Class
Socioeconomic status
Survival
Tissue Donors
Transplantation Conditioning
Treatment Outcome
Unrelated donor
Young Adult
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Summary: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 (
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2009.07.023