Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer?
Older patients are increasingly undergoing allogeneic hematopoietic transplantation. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/lymphoma patients age ≥50 years were analyzed comparing outcomes for recipients of MSD ≥50 (n = 1415) versus MUD <50 years (n = 757). Risks of acute graft-versus-host disease (GVHD) grade 2 to 4 (hazard ratio [HR], 1.63; P < .001), 3 to 4 (HR, 1.85; P < .001), and chronic GVHD (HR, 1.48; P < .0001) were higher after MUD compared with MSD transplants. The effect of donor type on nonrelapse mortality (NRM), relapse, and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR, 1.42; P = .001), relapse (HR, 1.45; P < .001), and overall mortality (HR, 1.28; P = .001) risks were higher after MUD transplants. For patients with scores below 90, NRM (HR, 0.96; P = .76), relapse (HR, 0.86; P = .25), and overall mortality (HR, 0.90; P = .29) were not significantly different after MUD and MSD transplants. These data favor an MSD over a MUD in patients age ≥50 years.
Department of Stem Cell Transplant and Cellular Therapy, University of Texas, M.D. Anderson Cancer Center, Houston, TX;
Amin M
AM
Alousi
Jennifer
J
Le-Rademacher
Rima M
RM
Saliba
Frederick R
FR
Appelbaum
Andrew
A
Artz
Jonathan
J
Benjamin
Steven M
SM
Devine
Fangyu
F
Kan
Mary J
MJ
Laughlin
Hillard M
HM
Lazarus
Jane
J
Liesveld
Miguel-Angel
MA
Perales
Richard T
RT
Maziarz
Mitchell
M
Sabloff
Edmund K
EK
Waller
Mary
M
Eapen
Richard E
RE
Champlin
D000367:Age Factors; D000368:Aged; D000375:Aging / Q000097:blood; D001788:Blood Grouping and Crossmatching; D015331:Cohort Studies; D046148:Donor Selection / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006805:Human Experimentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D035781:Siblings; D014184:Transplantation, Homologous; D061349:Unrelated Donors