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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)

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. (c) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

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

Keywords

  • ACCESS
  • ACUTE-LEUKEMIA
  • ADULTS
  • African American
  • Alternative donor
  • CYCLOPHOSPHAMIDE
  • Caucasian
  • GRAFT
  • HEMATOPOIETIC-CELL TRANSPLANTATION
  • IMPACT
  • NEED
  • SURVIVAL
  • leukemia
  • race
  • transplant-related mortality
  • GVHD

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