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

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

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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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