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Ancestry Assessments in BMT Prove Valuable

December 29, 2022

January 2023

Thomas R. Collins

Thomas R. Collins is a medical journalist based in West Palm Beach, Florida.

Ancestry assessments collected at initial registration by interviewing patients who will be undergoing bone marrow transplant (BMT) are frequently inaccurate, according to a study published in Blood Advances. Incorrect ancestry information can delay pursuing the best course for finding an unrelated donor, emphasizing the importance of having in-depth conversations with patients and their family members to ensure ancestry information is as accurate as possible, according to the authors.

Juliet Barker, MBBS, corresponding author and director of the Cord Blood Transplantation Program at Memorial Sloan Kettering (MSK) Cancer Center in New York City, said the findings suggest that incorrect ancestry information is fairly common in the BMT field.

“It is clear that in many cases accurate and complete collection of ancestry information requires dedicated questioning with a clear explanation of why such information is necessary and important,” she said. “I suspect this may be lacking in many instances.”

Since 2005, staff members with the BMT program at MSK have evaluated the ancestry of all allograft candidates without a human leukocyte antigen (HLA)-identical sibling donor. They explain to patients and their family members how ancestry is relevant and record each patient’s country of origin, along with that of the patient’s parents. They also record whether the patient identifies as Black or Hispanic. Ancestry is then classified as European, African, white Hispanic, Asian, Middle Eastern, or mixed non-European.

To make the process of finding an allograft as fast as possible, MSK has a “search prognosis tool” that gives an immediate estimation of the likelihood of securing an 8/8 – matched for HLA-A, -B, -C, and -DRB1 – unrelated donor (URD) without having an HLA-identical sibling. The accuracy of the tool is “greatly influenced by knowing whether a patient has European versus non-European origins,” the researchers noted.

“Recording patients with full or part non-European origins as ‘white’ non-Hispanic can result in inaccurate and potentially dangerous over-estimation of the likelihood of securing an 8/8 URD, thereby delaying pursuit of alternative mismatched adult donors or cord blood grafts,” researchers said.

In their retrospective review, Dr. Barker and colleagues found that out of 1,285 patients recorded as white/non-Hispanic at registration, 138 had non-European ancestry. Another 17 out of 370 who were registered as being from one non-white group were from a different non-European group, according to the ancestry history that staff obtained.

Eleven out of 370 who had been registered as having a race and ethnicity other than white/non-Hispanic had European history according to the MSK patient report, researchers said. Of the 30 patients registered as “other,” the history obtained by staff showed that two were European, 19 were white/Hispanic, one was African, three were Asian, four were Middle Eastern, and one was mixed non-European.

Of the 64 registered as “unknown” or “refused to answer,” all of them shared their history with staff and more than half had non-European ancestry, researchers said.

Dr. Barker said the findings help validate the center’s process of obtaining ancestry histories, which does not impose a significant time demand and has been made a part of the routine workflow.

“In this way, unrelated donor searches are more efficient, and alternative donors can be promptly pursued in the absence of a matched adult volunteer donor,” she said. “This avoids adverse transplant outcomes associated with prolonged and sometimes futile unrelated donor searches.”

Patients and their families have been very cooperative, she added.

“We have ensured that we explain why detailed ancestry information is needed and how this will help the patient’s care as well as ensure that we record the provision of transplants to all patient populations,” she said. “As a result, we have had 100% cooperation from patients and their families and very frequently [they] are more than happy to provide this information in great detail.”

Any conflicts of interest declared by the authors can be found in the original article.

Reference

Fingrut WB, Davis E, Chinapen S. Inaccuracies in assignment of patient race and ethnicity: implications for unrelated donor searches and healthcare delivery [published online, 2022 Sept 26]. Blood Adv. doi: 10.1182/bloodadvances.2022008526

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