title: Allogeneic stem cell transplantation for older advanced MDS patients: improved survival with young unrelated donor in comparison with HLA-identical siblings.
abstract: We investigated whether a young human leukocyte antigen (HLA)-matched unrelated donor (MUD) should be preferred as donor to an HLA-identical sibling (MRD) for older patients with myelodysplastic syndrome (MDS) (≥ 50 years) who underwent allogeneic stem cell transplantation (AHSCT). Outcomes of 719 MDS patients with a median age of 58 years (range, 50-73 years) who received AHSCT from related (n=555) or unrelated (n=164) donors between 1999 and 2008 and reported to the European Group for Blood and Marrow Transplantation were analyzed. The median donor age of the MRD was 56 years (range: 35-78), in contrast to 34 years (range: 19-64) for the MUDs. Influence of donor's age on survival was not observed for MRD (hazard ratio (HR): 1.01 (95% confidence interval (CI): 0.99-1.02), P=0.2), but there was a significant impact of MUD's age on outcome (HR: 1.03 (95% CI: 1.01-1.06); P=0.02). Transplantation from younger MUDs (<30 years) had a significant improved 5-year overall survival in comparison with MRD and older MUDs (>30 years): 40% vs 33% vs 24% (P=0.04). In a multivariate analysis, AHSCT from young MUD (<30 years) remained a significant factor for improved survival in comparison with MRD (HR: 0.65 (95% CI: 0.45-0.95), P=0.03), which should be considered in donor selection for older patients.
authors: Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
authors: N
authors: N
authors: Kröger
authors: T
authors: T
authors: Zabelina
authors: L
authors: L
authors: de Wreede
authors: J
authors: J
authors: Berger
authors: H
authors: H
authors: Alchalby
authors: A
authors: A
authors: van Biezen
authors: N
authors: N
authors: Milpied
authors: L
authors: L
authors: Volin
authors: M
authors: M
authors: Mohty
authors: V
authors: V
authors: Leblond
authors: D
authors: D
authors: Blaise
authors: J
authors: J
authors: Finke
authors: N
authors: N
authors: Schaap
authors: M
authors: M
authors: Robin
authors: T
authors: T
authors: de Witte
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D035781:Siblings; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens