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Trends in Survival Rates by Race after Allogeneic Hematopoietic Stem Cell Transplantation for Leukemia in the United States and Canada



Trends in Survival Rates by Race after Allogeneic Hematopoietic Stem Cell Transplantation for Leukemia in the United States and Canada



Blood 100(11): Abstract No 696, November 16



Survival differences among racial groups in the United States are reported in numerous diseases and treatments including cancer. Whether survival following allogeneic hematopoietic stem cell transplantation (HSCT) for leukemia differs by racial group is not known. We identified 6443 patients reported to the International Bone Marrow Transplant Registry and receiving HLA-identical sibling HSCT between 1985 and 1999 for acute or chronic leukemia in the United States or Canada. Racial groups were classified as white, black, Hispanic, or Asian. Cohorts were divided into three five-year time periods (1985 to 1989, 1990 to 1994, and 1995 to 1999) to analyze survival trends over time. Cox proportional hazards regression was used to compare the risk of mortality between whites and racial minorities while adjusting for statistically significant clinical prognostic factors. After adjusting for age, disease type and disease stage, the risk of mortality following HSCT was significantly higher among Hispanics than whites between 1995 and 1999. Hispanics had lower one-year (53% vs 65%; P<0.001) and three-year adjusted survival rates (38% vs 53%; P<0.001). The survival rates for blacks were lower than for whites in all time periods but none of the differences were statistically significant. Survival rates of Asians were similar to those of whites in all time periods. Overall survival for the entire cohort improved over time, from 56% to 63% at one year and from 43% to 51% at three years, with greater improvements noted among blacks (45% to 61% at one year and 34% to 48% at three years). We conclude that disparity in survival rates between whites and Hispanics remain despite adjusting for biological prognostic factors. Non-clinical factors such as socioeconomic status, healthcare access and delivery, or psychosocial and cultural variables may contribute to this disparity and should be further studied.

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