Race/ethnicity and socioeconomic status may impact mortality following development of GVHD after HCT

September 2024

Researchers showed that non-Hispanic Black recipients of allogeneic hematopoietic cell transplant (alloHCT) had higher incidence of severe (grade 3 or 4) acute graft-versus-host disease (GVHD) and higher transplant-related mortality (TRM) and overall mortality after an acute GVHD diagnosis compared to non-Hispanic White patients.

This study also showed that lower socioeconomic status (SES) was linked to an increased risk of disease relapse after development of acute GVHD but did not affect overall survival (OS) or TRM. Patients in the highest income quartile had improved OS and reduced TRM compared to those in the lowest quartile.

The results highlight health equity challenges experienced by underrepresented groups and the need for concentrated efforts to overcome them.

Download a PDF of study highlights

GVHD management after alloHCT may require long-term care and prolonged treatment, potentially influencing outcomes like OS, TRM and disease relapse. Researchers hypothesized that SES and race/ethnicity impact outcomes after development of GVHD following alloHCT, potentially exacerbating disparities and impeding health equity.

Researchers retrospectively analyzed CIBMTR® (Center for International Blood and Marrow Transplant Research®) outcomes data for 14,825 patients who received a first alloHCT for acute leukemia, myelodysplastic syndromes or myeloproliferative neoplasm between 2008–2018. They found 6,259 patients developed acute GVHD and 6,675 developed chronic GVHD. CIBMTR is a research collaboration between the Medical College of Wisconsin® and NMDP^SM.

Patient demographics included (acute GVHD; chronic GVHD):

• Non-Hispanic White: (n=5,015; 5,360)
• Non-Hispanic Black: (n=403; 420)
• Hispanic: (n=564; 590)
• Asian: (n=277; 305)

There were notable differences in baseline SES characteristics:

• Non-Hispanic Black cohorts had a higher proportion of median income <$48,000 compared with the non-Hispanic White cohort.
• A higher proportion of the non-Hispanic Black cohort had grade 3 or 4 acute GVHD (51.1%) vs. the non-Hispanic White (36%), Hispanic (38.2%) and Asian (37.8%) cohorts.

The study found that race and ethnicity did not significantly impact OS, TRM or disease relapse in patients with chronic GVHD. However, non-Hispanic Black patients had higher TRM and overall mortality compared to non-Hispanic White patients following an acute GVHD diagnosis:

• TRM: Hazard ratio (HR)=1.50, p=0.0001
• Overall mortality: HR=1.31, p=0.0002
• These associations disappeared when adjusted for acute GVHD severity.

Lower SES was linked to an increased risk of disease relapse (p=0.0016) after an acute GVHD diagnosis, but did not affect OS or TRM. Patients in the highest income quartile had improved OS and reduced TRM compared to those in the lowest quartile.

These results highlight ongoing health disparities for underrepresented groups, particularly non-Hispanic Black and low SES patients. Providers should ensure health care resources are available to patients with low SES and consider disparities in risks of severe GVHD when managing these patients post-HCT. Specific outreach and support programs for improving health equity outcomes for patients in underrepresented groups, coupled with early referral for transplant consultation, can help mitigate the impact of these disparities.

To help guide management of post-HCT effects, including GVHD, NMDP has newly updated its post-transplant care guidelines in collaboration with leading international transplant experts.

Farhardfar N, et al., published in Blood Advances