1. Optimal Donor for African Americans with Hematologic Malignancy: HLA-Haploidentical Relative or Umbilical Cord Blood Transplant
- Author
-
Solomon, Scott R, Martin, Andrew St, Zhang, Mei-Jie, Ballen, Karen, Bashey, Asad, Battiwalla, Minoo, Baxter-Lowe, Lee Ann, Brunstein, Claudio, Chhabra, Saurabh, Perez, Miguel Angel Diaz, Fuchs, Ephraim J, Ganguly, Siddhartha, Hardy, Nancy, Hematti, Peiman, McGuirk, Joseph, Peres, Edward, Ringden, Olle, Rizzieri, David, Romee, Rizwan, Solh, Melhem, Szwajcer, David, van der Poel, Marjolein, Waller, Edmund, William, Basem M, and Eapen, Mary
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Immunology ,Stem Cell Research ,Stem Cell Research - Nonembryonic - Human ,Clinical Research ,Transplantation ,Hematology ,Stem Cell Research - Umbilical Cord Blood/ Placenta - Human ,Rare Diseases ,Cancer ,Regenerative Medicine ,Stem Cell Research - Umbilical Cord Blood/ Placenta ,Good Health and Well Being ,Black or African American ,Cord Blood Stem Cell Transplantation ,Fetal Blood ,Graft vs Host Disease ,Hematologic Neoplasms ,Hematopoietic Stem Cell Transplantation ,Histocompatibility Testing ,Humans ,Alternative donor ,African American ,Caucasian ,race ,leukemia ,transplant-related mortality ,Clinical Sciences ,Cardiovascular medicine and haematology - Abstract
Although hematopoietic cell transplantation from an HLA-matched unrelated donor is potentially curative for hematologic malignancies, survival is lower for African Americans compared with Caucasians. Because only approximately 20% of African Americans will have an HLA-matched unrelated donor, many of these patients undergo HLA-haploidentical relative or umbilical cord blood transplantation. In this study, we analyzed outcomes after HLA-haploidentical related donor (n = 249) and umbilical cord blood (n = 118) transplantations in African American patients with hematologic malignancy between 2008 and 2016. The predominant disease was acute myelogenous leukemia for recipients of both types of donor grafts. The incidences of grade II-IV and III-IV acute graft-versus-host disease were higher after umbilical cord blood transplantation compared with HLA-haploidentical relative transplantation (56% and 29%, respectively, versus 33% and 11%, respectively; P < .0001). The 2-year incidence of transplantation-related mortality adjusted for age and conditioning regimen intensity was higher after umbilical cord blood transplantation compared with HLA-haploidentical related donor transplantation (31% versus 18%; P = .008); however, there were no between-group differences in the 2-year adjusted incidence of relapse (30% versus 34%; P = .51), overall survival (54% versus 57%; P = .66), or disease-free survival (43% versus 47%; P = .46). Our findings show that the use of HLA-haploidentical and umbilical cord blood transplants expands the access to transplantation with comparable leukemia-free and overall survival for African Americans with hematologic malignancies.
- Published
- 2020