Race as a Factor in Donor Selection and Survival of Children with
Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplant
in Florida
Abstract
Background Previous studies have explored post-hematopoietic cell
transplant (HCT) outcomes by race in adults; however, pediatric data
addressing this topic are scarce. Procedure This retrospective registry
study included 238 White (W) and 57 Black (B) children with hematologic
malignancies (HM) receiving first allogeneic HCT between 2010 and 2019
in one of five Florida pediatric HCT centers. Results We found no
differences between W and B children by transplant characteristics,
other than donor type. There was a significant difference in use of
HLA-mismatched donors (HLA-MMD) (53% W, 71% B, p=0.01). When comparing
HLA-MMD use to fully HLA-matched donors, B had RR of 1.47 [95% CI
0.7-3] of receiving a mismatched unrelated donor (MMUD), RR of 2.34
[95% CI 1.2-4.4] of receiving a mismatched related donor (MMRD),
and a RR of 1.9 [95% CI 0.99-3.6] of receiving a mismatched cord
blood donor (MMCBD) HCT, respectively. There was no significant
difference in the incidence of aGVHD (48% W, 35% B), p=0.1 or cGVHD
(19% W 28% B, p=0.1), or primary cause of death. Overall 24-month
survival was 61% [95% CI 54-68%] for W, and 60% [95% CI
38-68] for B children, log-rank p=0.72. While HLA matching improved
survival in W children, the number of B children receiving HLA-matched
HCT was too small to identify the impact of HLA matching on survival.
Conclusions In this contemporary cohort of children with HM we found
that B children were more likely to receive HLA-MMD transplants, but
this did not adversely affect survival or GVHD rates.