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

• Type of Material: Article
• Authors: Scott R Solomon, Northside Hospital; Andrew St Martin, Medical College of Wisconsin; Mei-Jie Zhang, Medical College of Wisconsin; Karen Ballen, University of Virginia Health System; Asad Bashey, Northside Hospital; Minoo Battiwalla, Centennial Medical Center; Lee Ann Baxter-Lowe, Children’s Hospital of Los Angeles; Claudio Brunstein, University of Minnesota, Minneapolis; Saurabh Chhabra, Medical College of Wisconsin; Miguel Angel Diaz Perez, Henry Ford Cancer Institute; Ephraim J Fuchs, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Siddhartha Ganguly, University of Kansas Health System; Nancy Hardy, University of Maryland; Peiman Hematti, University of Wisconsin Hospital and Clinics; Joseph McGuirk, University of Kansas Health System; Edward Peres, Henry Ford Hospital; Olle Ringden, Karolinska Institutet; David Rizzieri, Duke University; Rizwan Romee, Dana Farber Cancer Institute; Melhem Solh, Northside Hospital; David Szwajcer, University of Manitoba; Marjolein van der Poel, Maastricht University; Edmund Waller, Emory University; Basem M William, Ohio State University; Mary Eapen, Medical College of Wisconsin
• Language: English
• Date: 2020-10-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2020.06.029
• Title of Journal or Parent Work: BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
• Volume: 26
• Issue: 10
• Start Page: 1930
• End Page: 1936
• Grant/Funding Information: The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration or any other agency of the U.S. Government.; 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 (NIAID); 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research.
• Keywords: ACUTE-LEUKEMIA; GVHD; Transplantation; Hematology; ACCESS; ADULTS; HEMATOPOIETIC-CELL TRANSPLANTATION; Immunology; African American; leukemia; transplant-related mortality; Science & Technology; IMPACT; Caucasian; NEED; CYCLOPHOSPHAMIDE; Alternative donor; GRAFT; race; SURVIVAL; Life Sciences & Biomedicine

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.