Abstract：
BACKGROUND: Umbilical cord blood transplant (UCBT) improves access to transplant for patients lacking a fully matched donor. Previous Center for International Blood and Marrow Transplant Research (CIBMTR) showed that Black patients had a lower overall survival (OS) than White patients following single UCBT. The current study draws on a larger modern cohort and compares outcomes among White, Latinx, Black, and Asian patients.
OBJECTIVE: To compare outcomes by social determinants of health.
METHODS: We designed a retrospective study using CIBMTR data. US patients were between ages 1 and 80; 983 received single and 1529 double UCBT as reported to CIBMTR, following either a myeloablative (N = 1752) or reduced intensity conditioning (N = 759) for acute myeloid leukemia, acute lymphoid leukemia, or myelodysplasia. The primary outcome was 2-year OS. Secondary outcomes included disease free survival, transplant related mortality (TRM), acute and chronic graft vs host disease (GVHD), and GVHD free, relapse free survival (GRFS).
RESULTS: For 1705 adults, in univariate analysis, 2-year OS was 41.5% (99% CI, 37.6 to 45.3) for Whites, 36.1% (99% CI, 28.2 to 44.5) for Latinx, 45.8% (99% CI, 36.7 to 55.1) for Blacks, and 44.5% (99% CI, 33.6 to 55.6) for Asians. In multivariate analysis of adults, Latinx patients had inferior OS compared to black patients (p = .0005, HR 1.45, 99% CI 1.18 to 1.79). OS improved over time for all racial/ethnic groups. GVHD rates were comparable among the different racial/ethnic groups. In the 807 children, the 2-year OS in univariate analysis was 66.1% (99% CI, 59.7 to 72.2) for Whites, 57.1% (99%CI, 49 to 64.9) for Latinx, 46.8% (99%CI, 35.3 to 58.4) for Blacks, and 53.8% (99%CI, 32.7 to 74.2) for Asians. In multivariate analysis, no difference in OS was observed among racial/ethnic groups (p = .051). Grade III/IV acute GVHD was higher in Blacks compared with Whites (p = .0016, HR 2.25, 99% CI 1.36 to 3.74) and Latinx (p = .0016, HR 2.17, 99% CI 1.43 to 3.30). There was no survival advantage to receiving a UCB unit from a donor of similar race and ethnicity, for any racial/ethnic groups, for both children and adults. Black and Latinx adult patients were more likely to live in areas defined as high poverty. Patients from high poverty level areas had worse OS (p = .03), due to a higher rate of TRM (p=0.04). Educational level, and type of insurance did not impact overall survival, GVHD, TRM or other transplant outcomes. Children from areas with a higher poverty level had higher TRM, regardless of race and ethnicity (p = .02). Public health insurance, such as Medicaid, was also associated with a higher TRM (p = .02). However, poverty did not impact pediatric OS, DFS, or other post-transplant outcomes.
CONCLUSIONS: OS for UCBT has improved over time. In adults, OS is comparable among Whites, Blacks, and Asians and lower for Latinx patients. In children, OS is comparable among Whites, Blacks, Latinx, and Asians, but Grade III/IV acute GVHD was higher in Black patients. There was no survival benefit to matching UCB unit and patient by race and ethnicity for adults and children.
OBJECTIVE: To compare outcomes by social determinants of health.
METHODS: We designed a retrospective study using CIBMTR data. US patients were between ages 1 and 80; 983 received single and 1529 double UCBT as reported to CIBMTR, following either a myeloablative (N = 1752) or reduced intensity conditioning (N = 759) for acute myeloid leukemia, acute lymphoid leukemia, or myelodysplasia. The primary outcome was 2-year OS. Secondary outcomes included disease free survival, transplant related mortality (TRM), acute and chronic graft vs host disease (GVHD), and GVHD free, relapse free survival (GRFS).
RESULTS: For 1705 adults, in univariate analysis, 2-year OS was 41.5% (99% CI, 37.6 to 45.3) for Whites, 36.1% (99% CI, 28.2 to 44.5) for Latinx, 45.8% (99% CI, 36.7 to 55.1) for Blacks, and 44.5% (99% CI, 33.6 to 55.6) for Asians. In multivariate analysis of adults, Latinx patients had inferior OS compared to black patients (p = .0005, HR 1.45, 99% CI 1.18 to 1.79). OS improved over time for all racial/ethnic groups. GVHD rates were comparable among the different racial/ethnic groups. In the 807 children, the 2-year OS in univariate analysis was 66.1% (99% CI, 59.7 to 72.2) for Whites, 57.1% (99%CI, 49 to 64.9) for Latinx, 46.8% (99%CI, 35.3 to 58.4) for Blacks, and 53.8% (99%CI, 32.7 to 74.2) for Asians. In multivariate analysis, no difference in OS was observed among racial/ethnic groups (p = .051). Grade III/IV acute GVHD was higher in Blacks compared with Whites (p = .0016, HR 2.25, 99% CI 1.36 to 3.74) and Latinx (p = .0016, HR 2.17, 99% CI 1.43 to 3.30). There was no survival advantage to receiving a UCB unit from a donor of similar race and ethnicity, for any racial/ethnic groups, for both children and adults. Black and Latinx adult patients were more likely to live in areas defined as high poverty. Patients from high poverty level areas had worse OS (p = .03), due to a higher rate of TRM (p=0.04). Educational level, and type of insurance did not impact overall survival, GVHD, TRM or other transplant outcomes. Children from areas with a higher poverty level had higher TRM, regardless of race and ethnicity (p = .02). Public health insurance, such as Medicaid, was also associated with a higher TRM (p = .02). However, poverty did not impact pediatric OS, DFS, or other post-transplant outcomes.
CONCLUSIONS: OS for UCBT has improved over time. In adults, OS is comparable among Whites, Blacks, and Asians and lower for Latinx patients. In children, OS is comparable among Whites, Blacks, Latinx, and Asians, but Grade III/IV acute GVHD was higher in Black patients. There was no survival benefit to matching UCB unit and patient by race and ethnicity for adults and children.
摘要：
背景：脐带血移植（UCBT）改善了缺乏完全匹配供体的患者的移植途径。先前的国际血液和骨髓移植研究中心（CIBMTR）显示，黑人患者的总体生存率（OS）低于白人患者。当前的研究借鉴了一个更大的现代队列，并比较了怀特，Latinx,黑色,亚洲患者。
目的：比较健康的社会决定因素的结果。
方法：我们设计了一项使用CIBMTR数据的回顾性研究。美国患者年龄在1至80岁之间；根据CIBMTR的报告，983人接受了单UCBT和1529人接受了双UCBT，在清髓性（N=1752）或降低强度条件（N=759）治疗急性髓系白血病后，急性淋巴样白血病,或者骨髓增生异常.主要结果是2年OS。次要结果包括无病生存率，移植相关死亡率（TRM），急性和慢性移植物抗宿主病（GVHD），和GVHD免费，无复发生存率（GRFS）。
结果：对于1705名成年人，在单变量分析中，白人的两年OS为41.5%（99%CI，37.6-45.3），拉丁裔36.1%（99%CI，28.2-44.5），黑人的45.8%（99%CI，36.7-55.1），亚洲人占44.5%（99%CI，33.6-55.6）。在对成年人的多变量分析中，与黑人患者相比，Latinx患者的OS较差（p=0.0005，HR1.45，99％CI1.18-1.79）。随着时间的推移，所有种族/族裔群体的操作系统都得到了改善。不同种族/族裔群体的GVHD发生率相当。在807个孩子中，在单因素分析中，白人的2年OS为66.1%(99%CI，59.7-72.2)，拉丁裔57.1%（99CI，49-64.9），黑人占46.8％（99CI，35.3-58.4），亚洲人占53.8%（99CI，32.7-74.2）。在多变量分析中，在种族/族裔群体中,OS无差异(p=0.051).与白人（p=0.0016，HR2.25，99％CI1.36-3.74）和Latinx（p=0.0016，HR2.17，99％CI1.43-3.30）相比，黑人的III/IV级急性GVHD更高。从相似种族和种族的捐赠者那里获得UCB单位没有生存优势，对于任何种族/族裔群体，对于儿童和成人。黑人和拉丁裔成年患者更有可能生活在被定义为高贫困的地区。来自高贫困地区的患者OS较差（p=0.03），由于较高的TRM率(p=0.04)。教育水平,保险类型并不影响整体生存率，GVHD,TRM或其他移植结果。贫困率较高地区的儿童有较高的TRM，不分种族和民族（p=0.02）。公共健康保险,比如医疗补助，也与较高的TRM相关(p=0.02)。然而,贫困不会影响儿科OS，DFS,或其他移植后结果。
结论：UCBT的操作系统随着时间的推移有所改善。在成年人中,OS在白人中是可比的，黑人,和亚洲人，拉丁裔患者较低。在儿童中，OS在白人中是可比的，黑人,Latinx,亚洲人,但Black患者的III/IV级急性GVHD较高。成人和儿童按种族和种族匹配UCB单位和患者没有生存益处。
目的：比较健康的社会决定因素的结果。
方法：我们设计了一项使用CIBMTR数据的回顾性研究。美国患者年龄在1至80岁之间；根据CIBMTR的报告，983人接受了单UCBT和1529人接受了双UCBT，在清髓性（N=1752）或降低强度条件（N=759）治疗急性髓系白血病后，急性淋巴样白血病,或者骨髓增生异常.主要结果是2年OS。次要结果包括无病生存率，移植相关死亡率（TRM），急性和慢性移植物抗宿主病（GVHD），和GVHD免费，无复发生存率（GRFS）。
结果：对于1705名成年人，在单变量分析中，白人的两年OS为41.5%（99%CI，37.6-45.3），拉丁裔36.1%（99%CI，28.2-44.5），黑人的45.8%（99%CI，36.7-55.1），亚洲人占44.5%（99%CI，33.6-55.6）。在对成年人的多变量分析中，与黑人患者相比，Latinx患者的OS较差（p=0.0005，HR1.45，99％CI1.18-1.79）。随着时间的推移，所有种族/族裔群体的操作系统都得到了改善。不同种族/族裔群体的GVHD发生率相当。在807个孩子中，在单因素分析中，白人的2年OS为66.1%(99%CI，59.7-72.2)，拉丁裔57.1%（99CI，49-64.9），黑人占46.8％（99CI，35.3-58.4），亚洲人占53.8%（99CI，32.7-74.2）。在多变量分析中，在种族/族裔群体中,OS无差异(p=0.051).与白人（p=0.0016，HR2.25，99％CI1.36-3.74）和Latinx（p=0.0016，HR2.17，99％CI1.43-3.30）相比，黑人的III/IV级急性GVHD更高。从相似种族和种族的捐赠者那里获得UCB单位没有生存优势，对于任何种族/族裔群体，对于儿童和成人。黑人和拉丁裔成年患者更有可能生活在被定义为高贫困的地区。来自高贫困地区的患者OS较差（p=0.03），由于较高的TRM率(p=0.04)。教育水平,保险类型并不影响整体生存率，GVHD,TRM或其他移植结果。贫困率较高地区的儿童有较高的TRM，不分种族和民族（p=0.02）。公共健康保险,比如医疗补助，也与较高的TRM相关(p=0.02)。然而,贫困不会影响儿科OS，DFS,或其他移植后结果。
结论：UCBT的操作系统随着时间的推移有所改善。在成年人中,OS在白人中是可比的，黑人,和亚洲人，拉丁裔患者较低。在儿童中，OS在白人中是可比的，黑人,Latinx,亚洲人,但Black患者的III/IV级急性GVHD较高。成人和儿童按种族和种族匹配UCB单位和患者没有生存益处。
