Donor socioeconomic status affects hematopoietic stem cell transplant outcomes
Click Here to Manage Email Alerts
SALT LAKE CITY — Socioeconomic disadvantage among hematopoietic stem cell transplant donors appeared associated with poorer outcomes among transplant recipients, according to study results.
The findings — presented at Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR — indicate a biologic impact of socioeconomic status on hematopoietic cells that is transferrable from HSCT donor to recipient, researchers concluded.
Rationale and methods
“HSCT carries significant risk for morbidity and mortality, and risk varies based on multiple characteristics of the donor and recipient,” Jennifer M. Knight, MD, MS, FACLP, associate professor in the psychiatry and behavioral medicine department and the microbiology and immunology department at Medical College of Wisconsin, said during her presentation. “Low socioeconomic status among allogeneic HSCT recipients is associated with increased mortality risk, and chronic stress is a possible mechanism by which socioeconomic status may influence health outcomes, through increased systemic inflammation or altered gene expression patterns.”
Researchers sought to assess whether low socioeconomic status would impact donor hematopoietic cells, as well as whether the effect would be transferable to HSCT recipients and associated with adverse transplant outcomes.
Researchers identified 2,005 donor-recipient pairs through Center for International Blood and Marrow Transplant Research.
Recipients underwent HSCT between 2000 and 2013 for acute myeloid leukemia (55%), acute lymphocytic leukemia (16%), chronic myeloid leukemia (7%) or myelodysplastic syndrome (22%). All recipients received unrelated 8/8 HLA-matched peripheral blood stem cells.
Recipients had a median age at diagnosis of 51 years (range, 1-77; 56% men; 92% white).
Donors had a median age at donation of 34 years (range, 18-62; 64% men; 84% white).
Investigators pooled data from the U.S. Census Bureau American Community Survey on socioeconomic measures of household income, poverty, education, housing and employment. They used these five indicators to develop the standardized composite score.
They used multivariable models to evaluate associations between donor socioeconomic status composite score and recipient DFS, OS, treatment-related mortality, relapse, and rates of acute or chronic graft-versus-host disease.
Key findings
Median follow-up was 120 months (range, 4-219).
Multivariable analyses showed significant associations between donor socioeconomic status composite score and DFS (HR per standard deviation socioeconomic status = 1.07; 95% CI, 1.02-1.13), OS (HR per standard deviation socioeconomic status = 1.09; 95% CI, 1.04-1.15) and treatment-related mortality (HR per standard deviation socioeconomic status = 1.1; 95% CI, 1.03-1.17).
Compared with recipients of cells from donors of higher socioeconomic status, recipients of cells from donors of greater socioeconomic disadvantage appeared significantly less likely to achieve 3-year OS (38.2% vs. 47.9%) and significantly more likely to experience 3-year transplant-related mortality (30.8% vs. 24.2%).
Researchers observed no significant associations between donor socioeconomic status and relapse, acute GVHD or chronic GVHD.
“Importantly and interestingly, we did not find a relationship between the recipient socioeconomic composite score with any transplant outcome,” Knight said.
Knight acknowledged several study limitations, including lack of additional available data on donor health conditions and medications, and the fact socioeconomic status composite score may not fully represent donor status throughout time.
Next steps
Additional studies are underway to examine a stress- and socioeconomic status-associated pro-inflammatory gene expression profile among HSCT donors to see if it is associated with socioeconomic status or recipient HSCT outcomes, Knight said.
“We hope to validate our findings in a contemporary cohort, potentially with marrow donors,” she added. “Public health and other medical interventions targeting low socioeconomic status and its sequalae are needed to prevent social disparities in cancer treatment outcomes.”
Collapse
Knight JM, et al. Abstract 82. Presented at: Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR; April 23-26, 2022; Salt Lake City.
Click Here to Manage Email Alerts