Differences in Acute Graft-Versus-Host Disease (GVHD) Severity and Its Outcomes Between Black and White Patients.

Autor: Rios CAO; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Qayed M; Emory University School of Medicine, Atlanta, Georgia., Etra AM; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Reshef R; Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Irving Medical Center, New York, New York., Newcomb R; Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts., Yuhasz N; Division of Hematology, Blood and Marrow Transplantation Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio., Hexner EO; Department of Medicine and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Aguayo-Hiraldo P; Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California., Merli P; Department of Pediatric Hematology/Oncology and of Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy., Hogan WJ; Division of Hematology, Mayo Clinic, Rochester, Minnesota., Weber D; Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany., Kitko CL; Pediatric Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee., Ayuk F; Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Eder M; Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany., Grupp SA; Division of Oncology, Department of Pediatrics, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania., Kraus S; Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany., Sandhu K; City of Hope, Duarte, California., Ullrich E; Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt, Germany., Vasova I; Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany., Wölfl M; Pediatric Blood and Marrow Transplantation Program, Children's Hospital, University Hospital of Würzburg, Würzburg, Germany., Baez J; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Beheshti R; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Eng G; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Gleich S; Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt, Germany., Katsivelos N; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Kowalyk S; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Louloudis IE; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Morales G; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Spyrou N; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Young R; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Nakamura R; City of Hope, Duarte, California., Levine JE; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Ferrara JLM; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York., Akahoshi Y; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: akahoshiu@gmail.com.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2024 Nov; Vol. 30 (11), pp. 1061.e1-1061.e10. Date of Electronic Publication: 2024 Sep 01.
DOI: 10.1016/j.jtct.2024.08.019
Abstrakt: Acute graft-versus-host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation (HCT). Although recent advancements in GVHD prophylaxis have resulted in successful HCT across HLA barriers and expanded access to HCT for racial minorities, less is known about how race affects the severity and outcomes of acute GVHD. This study examines differences in the clinical course of acute GVHD and the prognostic value of GVHD biomarkers for Black and White recipients. We conducted a retrospective analysis of patients in the Mount Sinai Acute GVHD International Consortium (MAGIC) database who underwent HCT between 2014 and 2021 to describe the difference in clinical course of acute GVHD and significance of GVHD biomarkers between Black and White recipients. We used propensity score matching to generate a 1:3 matched cohort of 234 Black patients and 702 White patients with similar baseline characteristics. In the first year after HCT Black patients experienced a higher cumulative incidence of grade III-IV acute GVHD (17% versus 12%, P = 0.050), higher nonrelapse mortality (NRM; 18% versus 12%, P = .009), and lower overall survival that trended toward statistical significance (73% versus 79%, P = .071) compared to White patients. The difference in NRM in the first year was even greater among Black patients who developed GVHD than White patients (24% versus 14%, P = .041). The distribution of low, intermediate, and high MAGIC biomarker scores at the time of treatment was similar across racial groups (P = .847), however, Black patients with high biomarker scores experienced significantly worse NRM than White patients (71% versus 32%, P = .010). Our data indicate that Black patients are at a higher risk of NRM following HCT, primarily from a higher incidence of severe GVHD. Serum biomarkers at treatment initiation can stratify patients for risk of NRM across races, however Black patients with high biomarker scores had a significantly greater NRM risk. These results suggest a need for strategies that mitigate the higher risk for poor GVHD outcomes among Black patients.
(Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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