Trends in volumes and survival after hematopoietic cell transplantation in racial/ethnic minorities
Nandita Khera, Sikander Ailawadhi, Ruta Brazauskas, Jinalben Patel, Benjamin Jacobs, Celalettin Üstün, Karen K. Ballen, Muhammad Bilal Abid, Miguel Ángel Díaz, A. Samer Al‐Homsi, Hasan Hashem, Sanghee Hong, Reinhold Munker, Raquel M. Schears, Hillard M. Lazarus, Stefan O. Ciurea, Sherif M. Badawy, Bipin N. Savani, Baldeep Wirk, Charles F. LeMaistre, Neel S. Bhatt, Amer Beitinjaneh, Mahmoud Aljurf, Akshay Sharma, Jan Černý, Jennifer M. Knight, Amar H. Kelkar, Jean A. Yared, Tamila L. Kindwall‐Keller, Lena E. Winestone, Amir Steinberg, Staci D. Arnold, Sachiko Seo, Jaime M. Preussler, Nasheed Hossain, Warren Fingrut, Vaibhav Agrawal, Shahrukh K. Hashmi, Leslie Lehmann, William A. Wood, Hemalatha G. Rangarajan, Wael Saber, Theresa Hahn
Abstract
ABSTRACT: There has been an increase in volume as well as an improvement in overall survival (OS) after hematopoietic cell transplantation (HCT) for hematologic disorders. It is unknown if these changes have affected racial/ethnic minorities equally. In this observational study from the Center for International Blood and Marrow Transplant Research of 79 904 autologous (auto) and 65 662 allogeneic (allo) HCTs, we examined the volume and rates of change of autoHCT and alloHCT over time and trends in OS in 4 racial/ethnic groups: non-Hispanic Whites (NHWs), non-Hispanic African Americans (NHAAs), and Hispanics across 5 2-year cohorts from 2009 to 2018. Rates of change were compared using Poisson model. Adjusted and unadjusted Cox proportional hazards models examined trends in mortality in the 4 racial/ethnic groups over 5 study time periods. The rates of increase in volume were significantly higher for Hispanics and NHAAs vs NHW for both autoHCT and alloHCT. Adjusted overall mortality after autoHCT was comparable across all racial/ethnic groups. NHAA adults (hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.04-1.22; P = .004) and pediatric patients (HR 1.62; 95% CI 1.3-2.03; P < .001) had a higher risk of mortality after alloHCT than NHWs. Improvement in OS over time was seen in all 4 groups after both autoHCT and alloHCT. Our study shows the rate of change for the use of autoHCT and alloHCT is higher in NHAAs and Hispanics than in NHWs. Survival after autoHCT and alloHCT improved over time; however, NHAAs have worse OS after alloHCT, which has persisted. Continued efforts are needed to mitigate disparities for patients requiring alloHCT.