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Impact of race, ethnicity, and socioeconomic status on outcomes in patients with GvHD
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A retrospective analysis conducted by the CIMBTR assessed the association between race, ethnicity, and socioeconomic status and the incidence of GvHD and outcomes in patients after a GvHD diagnosis.1 This analysis included 14,825 adult patients with AML, ALL, MDS, or MPN who underwent first allo-HSCT in the US between 2008 and 2018. Results were published in Blood Advances by Farhadfar et al.1 |
| Key learnings: |
| In total, 6,259 and 6,675 patients were diagnosed with aGvHD and cGvHD, respectively. The cumulative incidence of severe aGvHD was higher in non-Hispanic Black patients compared with other racial/ethnic cohorts (p = 0.015). The cumulative incidence of cGvHD at 1, 3, and 5 years after allo-HSCT was not associated with race/ethnicity (p = 0.489) or socioeconomic status (p = 0.441). |
| In the multivariate analysis of patients with aGvHD, race/ethnicity was associated with OS (p = 0.0019) and TRM (p = 0.0002). Non-Hispanic Black patients had a higher overall mortality (HR, 1.31; 95% CI, 1.14–1.50; p = 0.0002) and TRM (HR, 1.5; 95% CI, 1.24–1.83; p = 0.0001) compared with non-Hispanic White patients. This association was lost when aGvHD severity was included as a covariate, suggesting that aGvHD severity partially explains the association of race/ethnicity with OS and TRM. Lower socioeconomic status was associated with an increased risk of relapse (p = 0.0013), but not OS or TRM. |
| Among patients with cGvHD, race/ethnicity was not associated with OS, TRM, or relapse. Socioeconomic status was associated with OS (p < 0.0001) and TRM (p = 0.0002). Patients with an annual household income of ≥$80,000 showed an improved OS (HR, 0.77; 95% CI, 0.69–0.85; p < 0.0001) and lower TRM (HR, 0.86; 95% CI, 0.67–0.87; p < 0.0001) compared with patients with an annual household income of <$48,000. |
| This analysis found that race/ethnicity and socioeconomic status had an impact on outcomes for patients with GvHD. Addressing these disparities in outcomes through better healthcare resource allocation for patients with a lower socioeconomic status and strategies to reduce the risk of severe aGvHD in non-Hispanic Black patients may improve long-term outcomes in clinical practice. |
Abbreviations: aGvHD, acute graft-versus-host disease; ALL, acute lymphoblastic leukemia; allo-HSCT, allogeneic hematopoietic stem cell transplants; AML, acute myeloid leukemia; cGvHD, chronic graft-versus-host disease; CI, confidence interval; CIMBTR, Center for International Blood and Marrow Transplant Research; GvHD, graft-versus-host disease; HR, hazard ratio; MDS, myelodysplastic syndromes; MPN, myeloproliferative neoplasms; OS, overall survival; TRM, transplant-related mortality.
- Farhadfar N, Rashid N, Chen K, et al. Racial, ethnic, and socioeconomic diversity and outcomes of patients with graft-versus-host disease: A CIBMTR analysis. Blood Adv. 2024;8(18):4963-4976. DOI: 1182/bloodadvances.2024013074
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