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Trends in Survival Rates After Allogeneic Hematopoietic Stem-Cell Transplantation for Acute and Chronic Leukemia by Ethnicity in the United States and Canada

Derek S. Serna, Stephanie J. Lee, Mei-jie Zhang, K. Scott Baker, Mary Eapen, Mary M. Horowitz, John P. Klein, J. Douglas Rizzo, Fausto R. Loberiza, Jr

From the International Bone Marrow Transplant Registry, Division of Biostatistics, Health Policy Institute, and Division of Neoplastic Diseases and Related Disorders, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA; and Pediatric Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN.

Address reprint requests to Fausto R. Loberiza Jr, MD, MS, International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; e-mail: faustol{at}mcw.edu.

Purpose: Differences in survival among ethnic groups in the United States are reported in numerous diseases and treatment strategies. Whether survival after allogeneic hematopoietic stem-cell transplantation (HSCT) differs by ethnicity is uncertain.

Patients and Methods: Patients (n = 6,443) receiving HLA-identical sibling HSCT for acute or chronic leukemia in the United States or Canada between 1985 and 1999 and reported to the International Bone Marrow Transplant Registry were included. The survival of recipients reported as white, black, Hispanic, or Asian was compared using Cox proportional hazards regression adjusting for other clinical factors. Three 5-year periods were studied to evaluate changes over time.

Results: Hispanics compared with whites had lower 1-year (53% v 65%; P < .001) and 3-year adjusted survival rates (38% v 53%; P < .001) between 1995 and 1999, the most recent period studied. We failed to find significant differences in survival rates comparing whites with blacks or with Asians in any of the time periods. Overall survival for the entire cohort improved over time, from 56% to 63% at 1 year and from 43% to 51% at 3 years, with greater improvements noted among blacks (45% to 61% at 1 year and 34% to 48% at 3 years).

Conclusion: Disparities remain in survival rates between whites and Hispanics despite adjustment for clinical factors. Factors not accounted for in this analysis, such as comorbid disease, socioeconomic status, healthcare access and delivery, and psychosocial and cultural variables, require further prospective study.

Presented orally during the 44th American Society of Hematology Annual Meeting in Philadelphia, PA, December 6–10, 2002.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

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