title: Birth order and transplantation outcome in HLA-identical sibling stem cell transplantation: an analysis on behalf of the Center for International Blood and Marrow Transplantation.
abstract: Allogeneic stem cell transplantation (SCT) is the most effective treatment option for many hematologic malignancies, but graft-versus-host disease (GVHD) remains a major cause of treatment failure. Along with well-established risk factors for transplantation outcomes, recent single-center studies have identified a birth order effect in HLA-identical sibling SCT, with lower rates of acute and chronic GVHD and improved overall survival when the donor is younger than the recipient. One hypothesized mechanism for this effect is microchimerism due to fetomaternal and transmaternal sibling cell trafficking during pregnancy as the donor is exposed to recipient antigens in utero. The aim of the present study was to validate previously reported single-center data in a large, multicenter cohort provided by the Center for International Blood and Marrow Transplantation. All adult and pediatric patients (n = 11,365) with a hematologic malignancy who underwent allogeneic SCT with a graft from an HLA-identical sibling donor between 1990 and 2007 were included. When donors were younger than recipients, there was a significantly lower rate of acute GVHD grade II-IV and chronic GVHD in children, as well as a lower rate of chronic GVHD in adolescents. However, the hypothesized overall positive effect of lower relapse and better survival when donors are younger than recipients was not observed. Our data suggest that if otherwise equally matched, a graft from a younger sibling may be superior to a graft from an older sibling for children and adolescents undergoing SCT.
authors: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany. Dobbelstein.Christiane@mh-hannover.de.
authors: Christiane
authors: C
authors: Dobbelstein
authors: Kwang Woo
authors: KW
authors: Ahn
authors: Michael
authors: M
authors: Haagenson
authors: Gregory A
authors: GA
authors: Hale
authors: Jon J
authors: JJ
authors: van Rood
authors: David
authors: D
authors: Miklos
authors: Edmund K
authors: EK
authors: Waller
authors: Stephen R
authors: SR
authors: Spellman
authors: Marcelo
authors: M
authors: Fernandez-Vina
authors: Arnold
authors: A
authors: Ganser
authors: Mahmoud
authors: M
authors: Aljurf
authors: Martin
authors: M
authors: Bornhaeuser
authors: Vikas
authors: V
authors: Gupta
authors: Susan R
authors: SR
authors: Marino
authors: Marilyn S
authors: MS
authors: Pollack
authors: Vijay
authors: V
authors: Reddy
authors: Matthias
authors: M
authors: Eder
authors: Stephanie J
authors: SJ
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D046528:Chimerism; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology*; D006682:HLA-DP Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D035781:Siblings; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006682:HLA-DP Antigens
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