Racial, ethnic, and socioeconomic diversity and outcomes of patients with graft-versus-host disease: a CIBMTR...

Area of Science:

• Hematology
• Transplant Immunology
• Health Services Research

Background:

• Socioeconomic status (SES) and race/ethnicity are linked to disparities in allogeneic hematopoietic stem cell transplantation (allo-HCT) outcomes.
• Graft-versus-host disease (GVHD) management, including long-term care and follow-up, may worsen existing health inequities.
• Understanding these associations is critical for improving allo-HCT care delivery and patient results.

Purpose of the Study:

• To investigate the association between SES, race/ethnicity, and outcomes in adult patients undergoing allo-HCT.
• To analyze the impact of GVHD on survival, transplant-related mortality (TRM), and disease relapse in relation to SES and race/ethnicity.
• To identify specific patient groups and factors contributing to disparities in allo-HCT.

Main Methods:

• Retrospective analysis of 14,825 adult patients undergoing first allo-HCT for leukemia, myelodysplastic syndrome, or myeloproliferative neoplasm (2008-2018).
• Data sourced from the Center for International Blood and Marrow Transplant Research, focusing on patients who developed acute GVHD (aGVHD) or chronic GVHD (cGVHD).
• Statistical models adjusted for patient and transplant variables to assess overall survival (OS), TRM, and disease relapse.

Main Results:

• Among patients with aGVHD, non-Hispanic Black patients showed higher TRM and mortality than non-Hispanic White patients, an association that diminished when GVHD severity was considered.
• Lower SES was linked to an increased risk of disease relapse but not OS or TRM.
• In patients with cGVHD, higher income (≥$80,000) correlated with improved OS and reduced TRM compared to the lowest income quartile, independent of race/ethnicity.

Conclusions:

• Race/ethnicity and SES significantly influence outcomes following GVHD after allo-HCT.
• Targeted interventions to support low SES patients and mitigate severe GVHD risk in non-Hispanic Black patients may improve long-term survival.
• Addressing socioeconomic and racial disparities is essential for equitable allo-HCT outcomes.