Optimal Donor for African Americans with Hematologic Malignancy: HLA-Haploidentical Relative or Umbilical Cord Blood Transplant

Scott R. Solomon, Andrew St Martin, Mei Jie Zhang, Karen Ballen, Asad Bashey, Minoo Battiwalla, Lee Ann Baxter-Lowe, Claudio Brunstein, Saurabh Chhabra, Miguel Angel Diaz Perez, Ephraim J. Fuchs, Siddhartha Ganguly, Nancy Hardy, Peiman Hematti, Joseph McGuirk, Edward Peres, Olle Ringden, David Rizzieri, Rizwan Romee, Melhem SolhDavid Szwajcer, Marjolein van der Poel, Edmund Waller, Basem M. William, Mary Eapen

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1930-1936
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number10
DOIs
StatePublished - Oct 2020

Bibliographical note

Funding Information:
Financial disclosure: The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; Grant 5U10HL069294 from the NHLBI and NCI; Contract HHSH250201200016C with the Health Resources and Services Administration (HRSA); and Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, HRSA, or any other agency of the US Government. Conflict of interest statement: There are no conflicts of interest to report. Financial disclosure: See Acknowledgments on page 1935.

Funding Information:
Financial disclosure: The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; Grant 5U10HL069294 from the NHLBI and NCI; Contract HHSH250201200016C with the Health Resources and Services Administration (HRSA); and Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, HRSA, or any other agency of the US Government.

Publisher Copyright:
© 2020 American Society for Transplantation and Cellular Therapy

Keywords

  • African American
  • Alternative donor
  • Caucasian
  • leukemia
  • race
  • transplant-related mortality

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

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