Graft-versus-host disease. Possible higher risk for African American patients

Race is not generally recognized as a factor in the severity or incidence of graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation. The impression that African American patients had more frequent and severe GVHD prompted this retrospective survey.

The records of 75 consecutive patients treated with a human leukocyte antigen-identical sibling bone marrow transplant from 1985 to 1993 were reviewed. GVHD prophylaxis uniformly employed cyclosporine and steroids. Treatment of GVHD included cyclosporine and high dose steroids in all cases. Antithymocyte globulin and other immunosuppressants were used in severe cases.

Of 75 patients, 56 (75%) were white, 11 (15%) were listed as "Hispanic", 7 (9%) were African Americans, and 1 was of Far-Eastern origin. Four of the African American patients had chronic myelogenous leukemia and 2 had acute leukemia, whereas 21 of the other 68 patients (31%) had chronic myelogenous leukemia, 31 (46%) had acute leukemia, and the remainder (33%) had miscellaneous hematologic malignancies. Transplants from a female donor to a male recipient were performed in 2 of 7 African Americans and 19 of 68 patients (28%) of other origins. Five of the 6 evaluable African American patients (83%; 95% confidence interval, 36-100%) had Grade 4 GVHD, as opposed to 5 of 61 patients of other racial origins (8%; 95% confidence interval, 3-18%). All African American patients died within 90 days of transplant.

Patients of African American origin possibly have a greater risk of GVHD.