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Racial and Socioeconomic Disparities in Long-Term Outcomes in ≥ 1 Year Allogeneic Hematopoietic Cell Transplantation Survivors

Jan 2024

CIBMTR® (Center for International Blood and Marrow Transplant Research®) analysis

Study details

This observational study focused on uncovering racial and socioeconomic outcome disparities among long-term allogeneic hematopoietic cell transplant (HCT) survivors.

Between 2007 to 2017, the study incorporated data from 5,473 first-time allogeneic HCT recipients in the U.S. who were over 18 years old and had achieved at least a year’s remission. Patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) or myelodysplastic syndrome (MDS) were included, covering all graft sources, donor types and conditioning regimens.

Download a copy here.

Results at a glance

  • The 5-year overall survival (OS) rates included Asians at 74%, Hispanics at 70%, and both non-Hispanic Whites and Blacks at 65%.
  • Cumulative non-relapse mortality (NRM) rates were lowest for Asians (13%), followed by Hispanics (16%),non-Hispanic Blacks (20%), and non-Hispanic Whites (21%).
  • Multivariable analyses revealed no discerned racial or ethnic disparities in OS or NRM
  • Residence type and insurance played a pivotal role, with rural dwellers and Medicaid/Medicare beneficiaries experiencing elevated mortality risks.
  • Causes of death were predominantly disease relapse, GVHD, infections, and organ failures, consistent across all racial and ethnic groups.
  • The mortality rates for the cohort were about 10 times that of the general population, exhibiting racialand ethnic discrepancies.

Figure: HCT Outcomes by Race/Ethnicity

HCT Outcomes by Race-Ethnicity

Clinical impact

While this study found no significant association between race/ethnicity, neighborhood poverty and long-term outcomes post-HCT, it did highlight vital elements influencing outcomes. The results underscore the critical need for enhanced post-transplant complication monitoring and an overhaul of care systems to ensure equitable outcomes for survivors. Incorporating innovative care models, including survivorship care plans, telemedicine, and digital self-management tools, is essential to promote the well-being of long-term survivors, especially those distant from their transplant centers.

Read the publication in Transplantation and Cellular Therapy (DOI: 10.1016/j.jtct.2023.07.013).