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ABILITY OF MINORITY PATIENTS TO FIND DONORS FROM AN ETHNICALLY DIVERSE CORD BLOOD BANK

Learn how ethnically diverse cord blood banks impact donor availability for diverse patients. Study on HLA matching and ethnicity influencing donation success rates, outcomes, and implications for transplant. Importance of high resolution HLA matching examined. Feasibility and effectiveness of creating diverse cord blood banks for improved patient outcomes evaluated.

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ABILITY OF MINORITY PATIENTS TO FIND DONORS FROM AN ETHNICALLY DIVERSE CORD BLOOD BANK

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  1. ABILITY OF MINORITY PATIENTS TO FIND DONORS FROM AN ETHNICALLY DIVERSE CORD BLOOD BANK Lee Ann Baxter-Lowe, Ph.D., Young Kim, M.S., Shelly Carter, Sc.D., Marcelo Fernandez-Vina, Ph.D., Elizabeth Wagner, M.P.H., LeeAnn Jensen, Ph.D., John Fraser, Ph.D., Nancy Kernan, M.D., and Joanne Kurtzberg, M.D. 7 The Cord Blood Transplantation Study (COBLT) Sponsored by the NIH

  2. Methods • Phase II multi-center study • Diseases • Malignancies • Immune deficiencies • Inherited marrow failure • Inborn errors of metabolism • UUCB bank minority donor recruitment • Self-reported enthnicity • HLA typing (NMRI, UCLA, UCSF) • HLA-A and –B - low/int resolution • HLA-DRB1 high resolution • Minimum of 1x107 TNC/kg (pre-cryopreservation). • 207 transplants from COBLT units (1999 - 2003 )

  3. Total Donors = 8038 1% 11% Caucasian (N = 3404) 9% African American (N = 1219) 42% Hispanic (N = 1774) Asian (N = 679) 22% Mixed (N = 901) Other (N = 61) 15% Ethnic Composition of the COBLT Bank (June 10, 2003)

  4. Active Searches: Best HLA Match Is Influenced by Recipient Ethnicity 335 Active Searches Potential HLA Match Recipient Ethnicity Unknown 6/6: 6% 5/6 or 4/6: 88%

  5. Ethnicity and HLA Matching at Transplant N = 207 HLA Match At Transplant Recipient Ethnicity 92%: 1 or 2 HLA mismatches AA predominantly 4/6

  6. Ethnicity of Donor-Recipient Pairs Donor Ethnicity Recipient Ethnicity Caucasian 77% African American 75% Asian 100% For Hispanic 35% Hispanic, 38% Caucasian

  7. HLA-A and -B Disparity Revealed by High Resolution Typing N=188 High Resolution HLA Match HLA Match At Transplant UnchangedOne Additional MMTotal 65% 4/6 29% of initial 4/6 M became 3/6 M 94 61% 5/6 29% of initial 4/6 M became 3/6 M 90 69% of 6/6 15% of initial 6/6 became 5/6 84

  8. High Resolution HLA Matching Is Influenced by Ethnicity Retrospective HLA Match Recipient Ethnicity 78% were at least 4/6 M 82% 6/6 were C

  9. Retrospective HLA Match by Original HLA Match Stratified by Recipient Ethnicity Caucasian (N=126) High Resolution HLA Match HLA Match At Transplant

  10. Retrospective HLA Match by Original HLA Match Stratified by Recipient Ethnicity African American (N=12) High Resolution HLA Match HLA Match At Transplant

  11. Retrospective HLA Match by Original HLA Match Stratified by Recipient Ethnicity Hispanic (N=30) High Resolution HLA Match HLA Match At Transplant

  12. Retrospective HLA Match by Original HLA Match Stratified by Recipient Ethnicity Asian (N=6) High Resolution HLA Match HLA Match At Transplant

  13. Summary • It was feasible to create UUCB banks with representation of each of the major US ethnic groups. • An ethnically diverse bank containing approximately 8,040 units provided at least one 4 of 6 HLA antigen matched unit with a minimum of 1x107 total nucleated cells/kg for 94% of patients (59% non-Caucasian). • For Caucasian, African American, and Asian recipients, the majority of the donor units were from the same ethnicity (77%, 75%, and 100%, respectively). For Hispanic recipients, only 35% were Hispanic while 38% were Caucasian donors. • For 188 patients with pre-transplant HLA matching determined using low/intermediate HLA-A and -B typing and high resolution HLA-DRB1 typing, 78% (n=146) were at least 4 of 6 HLA matched at a high resolution level. For UUCB transplantation, the importance of high resolution matching is under investigation. • Relatively small ethnically diverse UUCB banks can provide cord blood units to investigate if this HSC source is a suitable approach for diverse patient populations.

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