Racial, Ethnic and Socioeconomic Diversity and Outcomes of Patients with Graft-versus-Host Disease: A CIBMTR Analysis.
Nosha FarhadfarNahid RashidKaren ChenJakob D DeVosTao WangKaren Kuhn BallenAmer BeitinjanehVijaya Raj BhattBetty K HamiltonPeiman HemattiShahinaz M GadallaScott R SolomonNajla El JurdiCatherine J LeeMargaret L MacMillanHemalatha G RangarajanHélène M SchoemansAkshay SharmaStephen R SpellmanJohn R WingardStephanie J LeePublished in: Blood advances (2024)
Socioeconomic status (SES) and race/ethnicity have been associated with outcomes of allogeneic hematopoietic cell transplantation (allo-HCT). Certain aspects of GVHD management such as the need for long term care, prolonged immunosuppressive treatment, and need for close follow up for complications may exacerbate disparities. Adults (≥ 18 years) reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) who underwent a first alloHCT for acute leukemia, myelodysplastic syndrome, or myeloproliferative neoplasm between 2008 - 2018 were included. Endpoints 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 two-sided p-value < 0.01 was considered significant. Among the 14,825 allo-HCT recipients, 6,259 (42.2%) and 6,675 (45.0%) patients developed aGVHD and cGVHD, respectively. In patients with aGVHD, non-Hispanic Blacks had increased TRM (HR 1.50, 95% CI 1.24-1.83, p=0.0001) and overall mortality (HR 1.31, 1.14-1.50, p=0.0002) compared with non-Hispanic Whites, an association that disappeared when severity of aGVHD was included in the model. Lower SES was associated with increased risk of disease relapse (p=0.0016) but not OS or TRM. In patients who developed cGVHD, race and ethnicity were not associated with OS, TRM and disease relapse. However, the highest quartile of annual household income (≥ $80,000) had improved OS (HR 0.77, 0.69-0.85, p<0.0001) and reduced TRM (HR 0.86, 0.67-0.87, p<0.0001) compared with lowest quartile, adjusting for race and ethnicity. Race/ethnicity and SES are associated with outcomes after GVHD. Optimizing health care resources available to low SES patients and strategies to minimize the risk of severe GVHD in non-Hispanic Blacks may improve long-term outcomes.
Keyphrases
- end stage renal disease
- healthcare
- ejection fraction
- chronic kidney disease
- newly diagnosed
- risk factors
- long term care
- allogeneic hematopoietic stem cell transplantation
- free survival
- type diabetes
- physical activity
- cardiovascular events
- prognostic factors
- mental health
- low dose
- cell death
- high dose
- early onset
- case report
- coronary artery disease
- cell proliferation
- stem cell transplantation
- metabolic syndrome
- drug induced
- cell cycle arrest
- low grade
- affordable care act
- health insurance