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The impact of patient ethnicity on haematopoietic cell transplantation outcome: a retrospective cohort study on the UK experience.
The Lancet Haematology ( IF 15.4 ) 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

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.

中文翻译:


患者种族对造血细胞移植结果的影响:一项关于英国经验的回顾性队列研究。



背景 患者种族与造血细胞移植 (HCT) 后的不同结果相关,据报道,与白人患者相比,来自少数民族背景的患者预后更差。迄今为止,研究主要在美国进行,那里的医疗保健模式与包括英国在内的许多欧洲国家不同。我们旨在评估患者报告的种族对英国自体和同种异体 HCT 结局的影响。方法 在这项回顾性队列研究中,在 2009 年 1 月 1 日至 2019 年 12 月 31 日期间接受过自体或同种异体 HCT 并在英国血液和骨髓移植和细胞治疗学会患者登记处注册的患者被分析为完整队列和单独的成人 (≥18 岁) 和儿童 (0-17·9 岁) 队列。患者种族是自我定义的,分为四大类:亚洲、黑人、其他和白人。结果是 5 年总生存期,总生存期定义为从移植到因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 例首次同种异体 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)。在调整预后因素后,接受同种异体 HCT 的亚洲患者 (n=1081) 的 5 年总生存期 (风险比 [HR] 1·16 [95% CI 1·03-1·30],p=0·012) 显著差于白人患者 (n=11 705)。白人患者 (n=1489) 和亚洲患者 (n=384) 之间的总生存期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 年总生存期之间没有关联。解释 这项基于英国的大型分析表明,不同种族患者在同种异体 HCT 后的结果存在显著差异。原因尚不清楚,有必要进一步研究来阐明和改善这些健康不平等。资助 Anthony Nolan 慈善机构和英国血液和骨髓移植与细胞治疗学会。
更新日期:2024-12-01
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