Caprice on Racial and Ethnic Disparities in Transplant Outcomes in Hematologic Malignancies

Teresa Caprice, PA-C, medical oncology, Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, discusses the use of post-transplant cyclophosphamide to address disparities in outcomes of allogeneic hematopoietic cell transplantation (alloHCT) across racial and ethnic patient populations.

Challenges with accessibility, donor availability, and outcomes across racial and ethnic minority populations still occur for patients who are undergoing standard HCT. Although the use of post-transplant cyclophosphamide (PTCy) has improved the matching of transplant-eligible racial and ethnic minority populations to suitable donors, data on outcomes between racial and ethnic minority populations vs non-Hispanic White patients has been not been thoroughly investigated.

A retrospective analysis of 302 consecutive adult patients with hematologic malignancies undergoing haploidentical or mismatched unrelated donor (MMUD) HCT with PTCy at Moffitt Cancer Center between 2014 and 2022 were evaluated, Caprice details. The study addressed disparities in transplant outcomes between racial and ethnic minority patients and non-Hispanic White patients who received an HLA-mismatched transplant with PTCy, she explains.

The results demonstrated that the use of HLA-mismatched donor HCT with PTCy led to comparable clinical outcomes between both patient populations, which did not align with prior expectations, Caprice reports. There were no significant differences observed in any clinical outcomes between racial and ethnic minority patients and non-Hispanic White patients across all end points. Multivariate analysis further confirmed that race/ethnicity did not significantly impact the incidence of grade 2-4 acute graft-versus-host disease, moderate/severe chronic GVHD, rates of relapse, non-relapse mortality, relapse-free survival, or overall survival.

These findings suggest that the implementation of PTCy in HCT protocols has the potential to mitigate disparities in transplant outcomes. The study underscores the importance of addressing health disparities in HCT, particularly in terms of access to suitable donors and achieving equitable outcomes across diverse racial and ethnic populations, she concludes.