TY - JOUR
T1 - Analysis of disparities in time to allogeneic transplantation in adults with acute myelogenous leukemia
AU - Fingrut, Warren B.
AU - Gyurkocza, Boglarka
AU - Flynn, Jessica
AU - Davis, Eric
AU - Devlin, Sean
AU - Scaradavou, Andromachi
AU - Chinapen, Stephanie
AU - Quach, Sean
AU - Cho, Christina
AU - Giralt, Sergio A.
AU - Jakubowski, Ann A.
AU - Lin, Richard J.
AU - Papadopoulos, Esperanza B.
AU - Perales, Miguel Angel
AU - Ponce, Doris
AU - Shaffer, Brian C.
AU - Tamari, Roni
AU - Young, James W.
AU - Politikos, Ioannis
AU - Barker, Juliet N.
N1 - Funding Information:
This work was supported in part by a grant from the National Cancer Institute, National Institutes of Health (grant P30 CA008748).
Publisher Copyright:
© 2023 by The American Society of Hematology.
PY - 2023/8/8
Y1 - 2023/8/8
N2 - Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLAidentical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.
AB - Although alternative donors extend transplant access, whether recipient ancestry affects the time to allogeneic transplant is not established. We analyzed the likelihood of clinically significant delays to allograft by patient ancestry in 313 adult patients with acute myelogenous leukemia (AML) who underwent transplantation. Non-European ancestry patients (n = 99) were more likely than Europeans (n = 214) to receive HLA-mismatched donor allografts (45% vs 24%). Overall, the median time from transplant indication to allograft was 127 days (range, 57-1683). In multivariable analysis, non-Europeans had an increased risk of prolonged indication to transplant time >180 days owing to significant delays in indication to consult >90 days and consult to transplant >120 days. Compared with recipients of HLA-matched unrelated donors (URDs), HLA-mismatched adult donor recipients were at an increased risk of delayed indication to transplant, whereas HLAidentical sibling and cord blood recipients were at a lower risk. Subanalysis showed more indication to transplant delays >180 days in non-European (44%) vs European (19%) 8/8 URD recipients. Finally, the pandemic further exacerbated delays for non-Europeans. In summary, although non-European patients with AML are less likely to receive 8/8 URDs as expected, if they do, their transplants are delayed. HLA-identical siblings and cord blood facilitate the fastest transplants regardless of patient ancestry, whereas other adult donor transplants are delayed. Strategies to mitigate referral barriers, hasten donor evaluation, and use all alternative donor sources are critical to ensure timely transplantation for patients with AML.
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U2 - 10.1182/bloodadvances.2022008572
DO - 10.1182/bloodadvances.2022008572
M3 - Article
C2 - 36240477
AN - SCOPUS:85153692701
SN - 2473-9529
VL - 7
SP - 3824
EP - 3833
JO - Blood Advances
JF - Blood Advances
IS - 15
ER -