Black Children More Likely to Receive HLA Mismatched Donor Transplants

A new study out of Florida showed that among pediatric patients with hematologic malignancies, Black children were more likely to receive HLA-mismatched donor transplant, but that this did not adversely affect outcomes.

The retrospective study included 238 White and 57 Black children with hematologic malignancies receiving first allogeneic hematopoietic cell transplant (HCT) between 2010 and 2019 at one of five Florida pediatric transplant centers.

Other than donor type, there were no significant differences between White and Black patient groups.

HLA-mismatched donors were used in about half (53%) of White patients compared with 71% of Black patients (P = 0.01). The proportion of mismatched unrelated donor was similar between the two groups, but the proportion of mismatched unrelated donor and mismatched cord blood donors was not.

Looking at overall survival by race, there was no difference in survival between White and Black children. The 24-month overall survival was 61% for White children and 60% for Black children.

“Overall, our results are encouraging as they show that lack of HLA-matched donors did not translate into adverse HCT outcomes for B children,” the researchers wrote.

For White children, 24-month overall survival was significantly better for HLA-matched compared with HLA-mismatched transplant recipients (72% vs. 52%; P < 0.01). For Black children, there was no difference in overall survival between HLA-matched and HLA-mismatched transplant recipients (60% vs. 59%).

Additionally, despite higher use of HLA-mismatched donors, Black children did not have significantly higher rate of acute graft versus host disease (35% vs. 48%), death from recurrent disease (14% vs. 16%), and transplant related toxicity  (25% vs. 22%) compared with White children.