Socioeconomic status but not race and ethnicity is likely associated with chronic GVHD outcomes after allogeneic HCT

Dec 2022

Research presented at the 64th American Society of Hematology (ASH) Annual Meeting and Exposition explored the association of race, ethnicity and socioeconomic status (SES) with the incidence of chronic graft-versus-host disease (cGVHD) and overall long-term outcomes after allogeneic hematopoietic cell transplantation (alloHCT).

Researchers found that race and ethnicity was not significantly associated with overall survival (OS), transplant-related mortality (TRM), disease relapse, or the development of cGVHD in patients after alloHCT. However, the study did find that low SES, independent of race and ethnicity, was associated with negative outcomes in patients with cGVHD after alloHCT.  

Background 

Prior research studies have suggested that race, ethnicity and SES may negatively affect overall survival for patients after alloHCT. However, differences in the development of cGVHD by race, ethnicity or SES are relatively unknown. The treatment and prevention of cGVHD may include many facets, such as the need for long-term care, prolonged immunosuppressive regimens and close follow-up for complications. These areas may exacerbate the disparities related to race, ethnicity and SES after alloHCT.  

Study Details 

This study used data from the CIBMTR® (Center for International Blood and Marrow Transplant Research®) on 14,825 adults with acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), myelodysplastic syndrome (MDS), or myeloproliferative neoplasm (MPN) who received a first alloHCT between 2008-2018 in the U.S.

The recipient’s zip code at the time of alloHCT was used to estimate annual household income as the measure of SES. Patient groups included 11,796 non-Hispanic White, 1,009 non-Hispanic Black, 1,325 Hispanic, and 695 Asian patients. 

Results 

After alloHCT, 5,600 relapse-free patients developed cGVHD. Results suggest no significant difference in the development of cGVHD based on race, ethnicity or SES, which may indicate that patients develop cGVHD at the same rate regardless of racial, ethnic or socioeconomic background.

The study showed no significant difference in OS, TRM and disease relapse in patients with cGVHD based on race or ethnicity. However, the study did find that SES, regardless of race or ethnicity, was significantly associated with OS and TRM after alloHCT. Patients with the highest SES had better OS and TRM than patients with the lowest SES after the diagnosis of cGVHD, as shown in Table 1 below. 

Key Takeaways 

The study showed that race and ethnicity may not affect whether patients develop cGVHD, or singularly impact OS, TRM, or disease relapse after alloHCT. The study suggests that low SES, regardless of race or ethnicity, has a negative association with patient outcomes after diagnosis of cGVHD in alloHCT recipients.

Future research is needed to determine the extent of low SES on patients that develop cGVHD and their outcomes. Optimizing health care resources available to low SES patients and strategies to minimize the risk of cGVHD may improve long-term outcomes. NMDP is committed to partnering with organizations to expand access to necessary resources for patients needing alloHCT.

Table 1. Multivariable analysis of impact of socioeconomic status on alloHCT outcomes

Nosha F, et al., ASH poster presentation abstract