Racial and Socioeconomic Disparities in Long-Term Outcomes in ≥1 Year Allogeneic Hematopoietic Cell Transplantation Survivors: A CIBMTR Analysis: Transplantation and Cellular Therapy

B.J. Blue, R. Brazauskas, K. Chen, J. Patel, A.M. Zeidan, A. Steinberg, K. Ballen, J. Kwok, S.J. Rotz, M.A.D. Perez, A.H. Kelkar, S. Ganguly, J.R. Wingard, D. Lad, A. Sharma, S.M. Badawy, H.M. Lazarus, H. Hashem, D. Szwajcer, J.M. KnightN.S. Bhatt, K. Page, S. Beattie, Y. Arai, H. Liu, S.D. Arnold, C.O. Freytes, M.B. Abid, A. Beitinjaneh, N. Farhadfar, B. Wirk, L.E. Winestone, V. Agrawal, J.M. Preussler, S. Seo, S. Hashmi, L. Lehmann, W.A. Wood, H.G. Rangarajan, W. Saber, N.S. Majhail

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    1 Scopus citations

    Abstract

    Racial/ethnic minorities have demonstrated worse survival after allogeneic hematopoietic cell transplantation (HCT) compared to whites. Whether the racial disparity in HCT outcomes persists in long-term survivors and possibly may be even exacerbated in this population, which frequently transitions back from the transplant center to their local healthcare providers, is unknown. In the current study, we compared long-term outcomes among 1-year allogeneic HCT survivors by race/ethnicity and socioeconomic status (SES). The Center for International Blood and Marrow Transplant Research database was used to identify 5473 patients with acute myeloid leukemia, acute lymphocytic leukemia, chronic myeloid leukemia, or myelodysplastic syndromes who underwent their first allogeneic HCT between 2007 and 2017 and were alive and in remission for at least 1 year after transplantation. The study was restricted to patients who underwent HCT in the United States. SES was defined using patient neighborhood poverty level estimated from the recipient's ZIP code of residence; a ZIP code with ≥20% of persons below the federal poverty level was considered a high poverty area. The primary outcome was to evaluate the associations of race/ethnicity and neighborhood poverty level with overall survival (OS), relapse, and nonrelapse mortality (NRM). Cox regression models were used to determine associations of ethnicity/race and SES with OS, relapse, and NRM. Standardized mortality ratios were calculated to compare mortality rates of the study patients and their general population peers matched on race/ethnicity, age, and sex. The study cohort was predominately non-Hispanic white (n = 4385) and also included non-Hispanic black (n = 338), Hispanic (n = 516), and Asian (n = 234) patients. Overall, 729 patients (13%) resided in high-poverty areas. Significantly larger proportions of non-Hispanic black (37%) and Hispanic (26%) patients lived in high-poverty areas compared to non-Hispanic whites (10%) and Asians (10%) (P
    Original languageBritish English
    Pages (from-to)709.e1-709.e11
    JournalTransplant. Cell. Ther
    Volume29
    Issue number11
    DOIs
    StatePublished - 2023

    Keywords

    • Allogeneic hematopoietic cell transplantation
    • Disparities
    • Outcomes research
    • Socioeconomic status
    • Survival
    • Survivorship
    • Adult
    • Chronic Disease
    • Hematopoietic Stem Cell Transplantation
    • Humans
    • Recurrence
    • Retrospective Studies
    • Socioeconomic Disparities in Health
    • Survivors
    • Transplantation, Homologous
    • United States
    • acute lymphoblastic leukemia
    • acute myeloid leukemia
    • adult
    • aged
    • allogeneic hematopoietic stem cell transplantation
    • Article
    • Asian
    • cancer mortality
    • cancer regression
    • cancer survival
    • Caucasian
    • chronic myeloid leukemia
    • cohort analysis
    • controlled study
    • cumulative incidence
    • economic inequality
    • ethnicity
    • female
    • Hispanic
    • human
    • major clinical study
    • male
    • middle aged
    • mortality rate
    • myelodysplastic syndrome
    • outcome assessment
    • overall survival
    • poverty
    • poverty level
    • race
    • racial disparity
    • retrospective study
    • social status
    • standardized mortality ratio
    • survivor
    • transplantation
    • allotransplantation
    • chronic disease
    • health disparity
    • hematopoietic stem cell transplantation
    • recurrent disease

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