title: The effect of donor characteristics on survival after unrelated donor transplantation for hematologic malignancy.
abstract: There are >24 million registered adult donors, and the numbers of unrelated donor transplantations are increasing. The optimal strategy for prioritizing among comparably HLA-matched potential donors has not been established. Therefore, the objective of the current analyses was to study the association between donor characteristics (age, sex, parity, cytomegalovirus serostatus, HLA match, and blood group ABO match) and survival after transplantation for hematologic malignancy. The association of donor characteristics with transplantation outcomes was examined using either logistic or Cox regression models, adjusting for patient disease and transplantation characteristics associated with outcomes in 2 independent datasets: 1988 to 2006 (N = 6349; training cohort) and 2007 to 2011 (N = 4690; validation cohort). All donor-recipient pairs had allele-level HLA typing at HLA-A, -B, -C, and -DRB1, which is the current standard for selecting donors. Adjusting for patient disease and transplantation characteristics, survival was better after transplantation of grafts from young donors (aged 18-32 years) who were HLA matched to recipients (P < .001). These findings were validated for transplantations that occurred between 2007 and 2011. For every 10-year increment in donor age, there is a 5.5% increase in the hazard ratio for overall mortality. Increasing HLA disparity was also associated with worsening survival. Donor age and donor-recipient HLA match are important when selecting adult unrelated donors. Other donor characteristics such as sex, parity, and cytomegalovirus serostatus were not associated with survival. The effect of ABO matching on survival is modest and must be studied further before definitive recommendations can be offered.
authors.affiliation: Jaeb Center for Health Research, Tampa, FL;
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN;
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.affiliation: Center for International Blood and Marrow Transplant Research and Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN;
authors.forename: Anna
authors.initials: A
authors.lastname: Hassebroek
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;
authors.forename: Claudio
authors.initials: C
authors.lastname: Anasetti
authors.affiliation: Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN;
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Confer
authors.affiliation: Barnes Jewish Hospital, St. Louis, MO;
authors.forename: John F
authors.initials: JF
authors.lastname: DiPersio
authors.affiliation: Stanford Hospital & Clinics, Stanford, CA;
authors.forename: Marcelo
authors.initials: M
authors.lastname: Fernandez-Viña
authors.affiliation: C.W. Bill Young Marrow Donor Recruitment and Research Program, Department of Defense Marrow Donor Program, Bone Marrow Research Directorate, Naval Medical Research Center, Department of the Navy, Washington, DC;
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hartzman
authors.affiliation: Center for International Blood and Marrow Transplant Research and.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: Georgetown University, Washington, DC;
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Hurley
authors.affiliation: City of Hope National Medical Center, Duarte, CA;
authors.forename: Chatchada
authors.initials: C
authors.lastname: Karanes
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, MN;
authors.forename: Martin
authors.initials: M
authors.lastname: Maiers
authors.affiliation: ZKRD-Zentrales Knochenmarkspender-Register Deutschland, Ulm, Germany;
authors.forename: Carlheinz R
authors.initials: CR
authors.lastname: Mueller
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY;
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: National Marrow Donor Program/Be The Match, Minneapolis, MN;
authors.forename: Michelle
authors.initials: M
authors.lastname: Setterholm
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA;
authors.forename: Ann E
authors.initials: AE
authors.lastname: Woolfrey
authors.affiliation: American Red Cross Blood Services East Division, Dedham, MA; and.
authors.forename: Neng
authors.initials: N
authors.lastname: Yu
authors.affiliation: Center for International Blood and Marrow Transplant Research and Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006648:Histocompatibility / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D061349:Unrelated Donors / Q000706:statistics & numerical data*; D055815:Young Adult