A new study published in Blood Advances has highlighted the phenotypic impact of racial disparities on donor availability in African American (AA) patients with primary myelofibrosis (PMF).
The overall survival of AA patients was similar to nonAA patients, with a median survival of 4.8 years. However, posttransplant outcomes were inferior for AA patients, likely due to differences in donor sources, with greater use of haploidentical or mismatched transplants in AA patients. Besides, AA patients had higher posttransplant relapse rates than their nonAA counterparts reflecting referral bias to the tertiary center.
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The study aimed to characterize the clinical phenotype and genotype of AA patients with PMF and investigate the long-term survival outcomes of AA patients compared to their nonAA counterparts.
The researchers included 88 consecutive AA patients with PMF examined at various centers, including Mayo Clinic in Rochester, Minnesota (n=46), Moffitt Cancer Center in Tampa, Florida (n=34), and Montefiore Medical Center in Bronx, New York (n=8) between 1998 and 2022.
Survival and phenotype results were compared to a previously published cohort of nonBlack patients with PMF conducted by the Mayo Clinic. The clinical phenotype and genotype of AA patients were analyzed, and long-term survival outcomes were determined through various statistical analyses.
Study results revealed that 80% of the evaluable patients showed favorable karyotypes, 14% showed unfavorable, and 6% exhibited very high-risk karyotypes. Moreover, half of the patients had intermediate Dynamic International Prognostic Scoring System risk distribution. Additionally, 43% of AA patients demonstrated palpable splenomegaly, while 63% presented transfusion-dependent anemia and constitutional symptoms.
The results also suggest that AA patients with PMF were more likely to be younger, female, and belong to the lower-risk category than their non-AA counterparts. Moreover, the driver mutation profiles, and karyotype risk distribution were similar between the AA and nonAA patients.
The authors acknowledged limitations in the study, including comparing a multicenter AA cohort with a single institution nonAA population. “More studies are needed to validate these findings and further investigate the impact of racial disparities on transplant outcomes,” the study team added.
Past studies have reported racial and ethnic disparities in patients with acute myeloid leukemia, with studies reporting that Black patients with acute myeloid leukemia experience a greater risk of death than White patients, irrespective of their younger age and favorable cytogenetics. The phenotypic or prognostic impact of the Black race on PMF demands attention and needs comprehensive studies to be conducted to ensure an accurate understanding and appropriate management of the disease in this specific population.
Reference
Gangat N, Kuykendall A, Al Ali N, et al. Black African-American patients with primary myelofibrosis: a comparative analysis of phenotype and survival. Blood Advances. Published online June 14, 2023. doi:10.1182/bloodadvances.2022009611
