The impact of patient ethnicity on haematopoietic cell transplantation outcome: a retrospective cohort study on the UK experience.

IF 15.4 1区医学 Q1 HEMATOLOGY

Lancet Haematology Pub Date : 2024-12-01 DOI:10.1016/S2352-3026(24)00312-0

Neema P Mayor, Richard M Szydlo, Yasmin Sheikh, Julia Lee, Rachel M Pearce, Caitlin Farrow, Michaela Agapiou, Kanchan Rao, Kim Orchard, Eduardo Olavarria, Steven G E Marsh, John A Snowden

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引用次数: 0

Abstract

Background: Patient ethnicity has been correlated with different outcomes after haematopoietic cell transplantation (HCT), with patients from minority ethnic backgrounds reported to have worse outcomes compared with White patients. To date, studies have been predominantly done in the USA, where health-care models are different to many European countries, including the UK. We aimed to evaluate the impact of patient-reported ethnicity on autologous and allogeneic HCT outcomes in the UK.

Methods: In this retrospective cohort study, patients who had autologous or allogeneic HCT between Jan 1, 2009, and Dec 31, 2019, and were registered in the British Society of Blood and Marrow Transplantation and Cellular Therapy patient registry were analysed as full cohorts and as separate adult (≥18 years) and paediatric (0-17·9 years) cohorts. Patient ethnicity was self-defined and grouped into four broad categories: Asian, Black, Other, and White. The outcome was 5-year overall survival, with overall survival defined as the time from transplantation to death from any cause.

Findings: 20 119 first autologous HCTs and 13 978 first allogeneic HCTs were analysed. Median times to follow-up were 60 months (IQR 35-89) for patients receiving autologous HCT and 32 months (10-68) for patients receiving allogeneic HCT. 5-year overall survival for the full allogeneic HCT cohort was 55% (95% CI 51-58). After adjustment for prognostic factors, Asian patients undergoing allogeneic HCT (n=1081) had significantly worse 5-year overall survival (hazard ratio [HR] 1·16 [95% CI 1·03-1·30], p=0·012) than White patients (n=11 705). Differences in overall survival between White (n=1489) and Asian patients (n=384) were most pronounced in paediatric patients (HR 1·67 [95% CI 1·28-2·19], p=0·00018). In the autologous HCT cohort, there were no associations between ethnicity and 5-year overall survival.

Interpretation: This large UK-based analysis suggests significant variation in outcomes after allogeneic HCT between patients of different ethnicities. The causes are unclear, and further research to elucidate and improve these health inequalities is warranted.

Funding: Anthony Nolan Charity and British Society of Blood and Marrow Transplantation and Cellular Therapy.

查看原文本刊更多论文

患者种族对造血细胞移植结果的影响：英国经验的回顾性队列研究。

背景：患者的种族与造血细胞移植（HCT）后的不同结果相关，据报道，少数民族背景的患者与白人患者相比预后更差。迄今为止，研究主要是在美国进行的，美国的医疗保健模式与包括英国在内的许多欧洲国家不同。我们的目的是评估英国患者报告的种族对自体和异体HCT结果的影响。方法：在这项回顾性队列研究中，2009年1月1日至2019年12月31日期间在英国血液和骨髓移植和细胞治疗协会患者登记处登记的自体或异体HCT患者被分为完整队列和单独的成人（≥18岁）和儿科（0- 17.9岁）队列进行分析。患者的种族是自我定义的，并分为四大类：亚洲人、黑人、其他人种和白人。结果是5年总生存率，总生存率定义为从移植到任何原因死亡的时间。结果：分析了20 119例首次自体hct和13 978例首次异体hct。接受自体HCT的患者中位随访时间为60个月（IQR 35-89），接受同种异体HCT的患者中位随访时间为32个月（10-68）。全同种异体HCT队列的5年总生存率为55% （95% CI 51-58）。校正预后因素后，接受同种异体HCT的亚洲患者（n=1081）的5年总生存率（风险比[HR] 1.16 [95% CI 1.03 -1·30],p= 0.012）明显低于白人患者（n=11 705）。白人（n=1489）和亚洲患者（n=384）的总生存率差异在儿科患者中最为明显（HR 1.67 [95% CI 1.28 -2·19],p= 0.00018）。在自体HCT队列中，种族与5年总生存率之间没有关联。解释：这项基于英国的大型分析表明，不同种族的患者接受同种异体HCT后的结果存在显著差异。原因尚不清楚，有必要进一步研究以阐明和改善这些健康不平等。资助：安东尼诺兰慈善机构和英国血液和骨髓移植和细胞治疗协会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Haematology HEMATOLOGY-

CiteScore

26.00

自引率

0.80%

发文量

323

期刊介绍： Launched in autumn 2014, The Lancet Haematology is part of the Lancet specialty journals, exclusively available online. This monthly journal is committed to publishing original research that not only sheds light on haematological clinical practice but also advocates for change within the field. Aligned with the Lancet journals' tradition of high-impact research, The Lancet Haematology aspires to achieve a similar standing and reputation within its discipline. It upholds the rigorous reporting standards characteristic of all Lancet titles, ensuring a consistent commitment to quality in its contributions to the field of haematology.