Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
School of Public Health, University of Texas Health Science Center, Houston, Texas.
Biol Blood Marrow Transplant. 2018 Jun;24(6):1237-1242. doi: 10.1016/j.bbmt.2018.01.024. Epub 2018 Feb 13.
Available evidence from large registry studies has shown inferior survival for black adult patients following both unrelated donor and cord blood transplantation. Post-transplant cyclophosphamide (PTCy)-based haploidentical donor transplantation (HIDT) is being increasingly used in ethnic minorities. However, no studies of the impact of race on outcomes following HIDT have been reported. We analyzed 203 consecutive patients (123 white, 80 black) who underwent first HIDT using PTCy for hematologic malignancy at a single institution. Median recipient age was 53 (range, 19-75) years. Peripheral blood stem cells (PBSCs) were used as the stem cell source in 66% of patients, and conditioning intensity was myeloablative (MA) in 41%. After a median follow-up of 36 months, the estimated 3-year overall survival (OS), disease-free survival (DFS), and cumulative incidence of relapse (CIR) were significantly better in black patients, compared with white patients (72% [95% confidence interval (CI), 60% to 81%], 65% [95% CI, 52% to 75%], and 25% [95% CI, 16% to 35] versus 50% [95% CI, 40% to 59%], 45% [95% CI, 36% to 54%], and 39% [95% CI, 31% to 47%], respectively; P < .001 for OS and DFS, P = .015 for CIR). In contrast, 3-year nonrelapse mortality was similar between black (11%) and white (16%) patients, as were the incidences of acute graft-versus-host disease (GVHD) and moderate-to-severe chronic GVHD. Improved survival was noted in all subgroups of black patients-younger versus older, male versus female, lower versus higher disease risk index, MA versus non-MA conditioning, or PBSC versus marrow stem cell source. In multivariate analysis, black race was independently associated with better OS (hazard ratio [HR], .47; P = .003), DFS (HR, .49; P = .003), and relapse (HR, .49; P = .01). Black patients achieve superior outcomes to their white counterparts following PTCy-based HIDT due to a decreased incidence of disease relapse.
现有的大型注册研究证据表明，在接受无关供体和脐带血移植后，黑人成年患者的生存率较低。基于环磷酰胺（PTCy）的单倍体相合供体移植（HIDT）越来越多地用于少数民族。然而，目前还没有研究报告种族对 HIDT 后结果的影响。我们分析了在一家机构接受 PTCy 治疗血液系统恶性肿瘤的 203 例连续患者（白人 123 例，黑人 80 例）。中位受者年龄为 53 岁（19-75 岁）。66%的患者使用外周血干细胞（PBSC）作为干细胞来源，41%的患者采用清髓性预处理。中位随访 36 个月后，与白人患者相比，黑人患者的 3 年总生存率（OS）、无病生存率（DFS）和累积复发率（CIR）显著更好（72%[95%CI，60%-81%]、65%[95%CI，52%-75%]和 25%[95%CI，16%-35%]比 50%[95%CI，40%-59%]、45%[95%CI，36%-54%]和 39%[95%CI，31%-47%]；OS 和 DFS 的 P 值均＜.001，CIR 的 P 值为.015）。然而，黑人（11%）和白人（16%）患者的 3 年非复发死亡率相似，急性移植物抗宿主病（GVHD）和中重度慢性 GVHD 的发生率也相似。在所有黑人患者亚组中，包括年轻与年长、男性与女性、疾病风险指数低与高、清髓性与非清髓性预处理或 PBSC 与骨髓干细胞来源，都观察到了生存改善。多变量分析显示，黑人种族与更好的 OS（风险比[HR]，.47；P=0.003）、DFS（HR，.49；P=0.003）和复发（HR，.49；P=0.01）独立相关。由于疾病复发率降低，黑人患者在接受 PTCy 为基础的 HIDT 后比白人患者获得更好的结果。
