Mielcarek Marco, Gooley Theodore, Martin Paul J, Chauncey Thomas R, Young Bessie A, Storb Rainer, Torok-Storb Beverly
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Biol Blood Marrow Transplant. 2005 Mar;11(3):231-9. doi: 10.1016/j.bbmt.2004.12.327.
Effects of race or ethnicity on survival after high-dose chemoradiation followed by stem cell transplantation (SCT) have not been thoroughly evaluated. We analyzed survival according to racial/ethnic categories for 3587 consecutive patients who had SCT at a single US institution between July 1992 and December 2000. Among 1366 patients who received autologous SCT, race or ethnicity was not significantly associated with survival. In contrast, among 2221 patients who received allogeneic SCT from HLA-matched unrelated or sibling donors, blacks had a significantly greater mortality than whites (unadjusted hazard ratio, 1.65; 95% confidence interval, 1.21-2.25). Mortality among other racial or ethnic groups was not significantly different from that among whites. The greater mortality hazard among blacks persisted after controlling for donor type, pretransplantation risk category, patient age, donor/patient sex, and cytomegalovirus exposure (hazard ratio, 1.71; 95% confidence interval, 1.25-2.34). SCT from both HLA-matched unrelated and HLA-identical sibling donors was associated with more severe acute graft-versus-host disease and higher nonrelapse mortality among blacks compared with whites. Furthermore, blacks who received SCT for chronic myeloid leukemia had longer diagnosis-to-transplantation intervals than whites. A matched-cohort analysis showed that the higher mortality among blacks could not be explained by obvious socioeconomic differences. The higher incidence of severe graft-versus-host disease among blacks compared with whites, both with HLA-identical sibling donors, might be related to yet-unidentified "immune-enhancing" genetic polymorphisms. We cannot exclude the possibility that the increased mortality risk among blacks after discharge from the transplant center might in part be related to unidentified sociocultural differences that influence medical care.
种族或族裔对大剂量放化疗后接受干细胞移植（SCT）患者生存的影响尚未得到充分评估。我们分析了1992年7月至2000年12月期间在美国一家机构连续接受SCT的3587例患者按种族/族裔分类的生存情况。在1366例接受自体SCT的患者中，种族或族裔与生存无显著相关性。相比之下，在2221例接受来自HLA匹配的无关供体或同胞供体的异基因SCT的患者中，黑人的死亡率显著高于白人（未调整风险比，1.65；95%置信区间，1.21 - 2.25）。其他种族或族裔群体的死亡率与白人无显著差异。在控制供体类型、移植前风险类别、患者年龄、供体/患者性别和巨细胞病毒暴露后，黑人较高的死亡风险仍然存在（风险比，1.71；95%置信区间，1.25 - 2.34）。与白人相比，来自HLA匹配的无关供体和HLA相同的同胞供体的SCT在黑人中与更严重的急性移植物抗宿主病和更高的非复发死亡率相关。此外，接受慢性髓性白血病SCT的黑人从诊断到移植的间隔时间比白人长。一项匹配队列分析表明，黑人较高的死亡率无法用明显的社会经济差异来解释。与白人相比，黑人中严重移植物抗宿主病的发生率较高，在HLA相同的同胞供体中，这可能与尚未确定的“免疫增强”基因多态性有关。我们不能排除黑人从移植中心出院后死亡风险增加可能部分与影响医疗护理的未确定的社会文化差异有关的可能性。
