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. 2013 Aug;19(8):1197-203.
doi: 10.1016/j.bbmt.2013.05.020. Epub 2013 Jun 6.

Significance of ethnicity in the risk of acute graft-versus-host disease and leukemia relapse after unrelated donor hematopoietic stem cell transplantation

Yasuo Morishima  1 , Takakazu Kawase, Mari Malkki, Satoko Morishima, Stephen Spellman, Koichi Kashiwase, Shunichi Kato, Anne Cesbron, Jean-Marie Tiercy, David Senitzer, Andrea Velardi, Effie W Petersdorf; International Histocompatibility Working Group in Hematopoietic Cell Transplantation
Collaborators, Affiliations

Significance of ethnicity in the risk of acute graft-versus-host disease and leukemia relapse after unrelated donor hematopoietic stem cell transplantation

Yasuo Morishima et al. Biol Blood Marrow Transplant. 2013 Aug.

Abstract

The significance of patient and donor ethnicity on risk of acute graft-versus-host disease (GVHD) and disease relapse after unrelated donor hematopoietic cell transplantation (HCT) is not known. A total of 4335 patient-donor pairs from the International Histocompatibility Working Group in HCT met the following 3 criteria: (1) HLA-A, -B, -C, -DRB1, and -DQB1 allele matched donor, (2) diagnosis of leukemia, and (3) non-T cell depleted GVHD prophylaxis. Posttransplantation risks of acute GVHD and leukemia relapse were defined in Asian/Pacific Islander, white, African American, Hispanic, and Native American patients that underwent transplantation from donors with the same self-described background. Asian patients had a significantly lower incidence of acute GVHD (Japanese patients: 40.0% grades II to IV and 15.3% grades III to IV; non-Japanese Asian patients: 42.1% grades II to IV and 15.7% grades III to IV) compared with white patients (56.5% grades II to IV and 22.6% grades III to IV) (P < .001). The hazard ratio of acute GVHD for white patients was significantly higher than for Japanese patients. Unexpectedly, the hazard ratio of leukemia relapse in white patients with early disease status was also significantly higher than that in Japanese patients. These results provide a platform for future investigation into the genetic factors for unrelated donor HCT and clinical implications of diverse ethnic background.

Keywords: Acute Graft-versus-host disease; Ethnicity; Leukemia relapse; Unrelated donor transplantation.

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Figures

Figure 1
Figure 1
Cumulative incidence of acute GVHD by ethnicity. (A) Grades II-IV acute GVHD; (B) grades III-IV acute GVHD. JJ, Japanese donor and patient pair; CC, Caucasian donor and patient pair; AfAf, African American donor and patient pair; HH, Hispanic donor and patient pair; API non-JJ, Asian/Pacific Islander donor and patients excluding Japanese pair; MM, Mismatch race/ethnicity pair between donor and patients. Incidence of acute GVHD is shown in Supplemental Table S1.
Figure 1
Figure 1
Cumulative incidence of acute GVHD by ethnicity. (A) Grades II-IV acute GVHD; (B) grades III-IV acute GVHD. JJ, Japanese donor and patient pair; CC, Caucasian donor and patient pair; AfAf, African American donor and patient pair; HH, Hispanic donor and patient pair; API non-JJ, Asian/Pacific Islander donor and patients excluding Japanese pair; MM, Mismatch race/ethnicity pair between donor and patients. Incidence of acute GVHD is shown in Supplemental Table S1.
Figure 2
Figure 2
Survival after transplantation by ethnicity. (A) Patients with early status of leukemia at transplantation; (B) patients with advanced status of leukemia at transplantation. Early status: 1st and 2nd complete remission of ALL or AML at transplantation, 1st chronic phase of CML. Advanced status: more advanced status than early status. JJ, Japanese donor and patient pair; CC, Caucasian donor and patient pair; AfAf, African American donor and patient pair; HH, Hispanic donor and patient pair; API non-JJ, Asian/Pacific Islander donor and patients excluding Japanese pair; MM, Mismatch ethnicity pair between donor and patients. 5-year survival rate after transplantation by ethnicity is provided in Supplemental Table S1.
Figure 2
Figure 2
Survival after transplantation by ethnicity. (A) Patients with early status of leukemia at transplantation; (B) patients with advanced status of leukemia at transplantation. Early status: 1st and 2nd complete remission of ALL or AML at transplantation, 1st chronic phase of CML. Advanced status: more advanced status than early status. JJ, Japanese donor and patient pair; CC, Caucasian donor and patient pair; AfAf, African American donor and patient pair; HH, Hispanic donor and patient pair; API non-JJ, Asian/Pacific Islander donor and patients excluding Japanese pair; MM, Mismatch ethnicity pair between donor and patients. 5-year survival rate after transplantation by ethnicity is provided in Supplemental Table S1.
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