title: Allogeneic unrelated bone marrow transplantation from older donors results in worse prognosis in recipients with aplastic anemia.
abstract: Allogeneic bone marrow transplantation is an essential therapy for acquired aplastic anemia and prognosis has recently improved. However, engraftment failure and graft-versus-host disease are potential fatal complications. Various risk factors for poor prognosis have been identified, such as patient age and human-leukocyte antigen disparity, but the relationship between donor age and prognosis is still unknown. Therefore, we performed a cohort study to compare the prognosis of unrelated bone marrow transplantation from younger and older donors using the registry database in Japan. We evaluated 427 patients (age 16-72 years) with aplastic anemia who underwent bone marrow transplantation from younger (≤39 years, n=281) or older (≥40 years, n=146) unrelated donors. Overall survival of the older donor group was significantly inferior to that of the younger donor group (adjusted hazard ratio 1.64; 95% confidence interval 1.15-2.35; P<0.01). The incidence of fatal infection was significantly higher in the older donor group (13.7% vs. 7.5%; P=0.03). Primary engraftment failure and acute graft-versus-host disease were significantly more frequent in the older donor group (9.7% vs. 5.0%; adjusted hazard ratio 1.30; P=0.01, and 27.1% vs. 19.7%; adjusted hazard ratio 1.56; P=0.03, respectively). Acute graft-versus-host disease was related to a worse prognosis in the whole cohort. This study showed the inferiority of older donors in aplastic anemia; thus, donor age should be considered when multiple donors are available. A large-scale prospective study is warranted to establish a better donor selection algorithm for bone marrow transplantation in aplastic anemia.
authors: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Tokyo, Japan.
authors: Yasuyuki
authors: Y
authors: Arai
authors: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Tokyo, Japan tadakazu@kuhp.kyoto-u.ac.jp.
authors: Tadakazu
authors: T
authors: Kondo
authors: Division of Transfusion Medicine, Kanazawa University Hospital, Tokyo, Japan.
authors: Hirohito
authors: H
authors: Yamazaki
authors: Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicinal Sciences, Fukuoka, Tokyo, Japan.
authors: Katsuto
authors: K
authors: Takenaka
authors: Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Tokyo, Japan.
authors: Junichi
authors: J
authors: Sugita
authors: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors: Takeshi
authors: T
authors: Kobayashi
authors: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Tokyo, Japan.
authors: Yukiyasu
authors: Y
authors: Ozawa
authors: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors: Naoyuki
authors: N
authors: Uchida
authors: Department of Hematology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Tokyo, Japan.
authors: Koji
authors: K
authors: Iwato
authors: Department of Hematology, Sapporo Hokuyu Hospital, Tokyo, Japan.
authors: Naoki
authors: N
authors: Kobayashi
authors: Department of Pediatrics, Nagoya University Graduate School of Medicine, Tokyo, Japan.
authors: Yoshiyuki
authors: Y
authors: Takahashi
authors: Department of Hematology, Kanazawa University Hospital, Tokyo, Japan.
authors: Ken
authors: K
authors: Ishiyama
authors: Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Takahiro
authors: T
authors: Fukuda
authors: Department of Hematology and Oncology, Hiroshima University Hospital, Tokyo, Japan.
authors: Tatsuo
authors: T
authors: Ichinohe
authors: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Tokyo, Japan Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Tokyo, Japan.
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
authors: Takehiko
authors: T
authors: Mori
authors: Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Tokyo, Japan.
authors: Takanori
authors: T
authors: Teshima
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000741:Anemia, Aplastic / Q000401:mortality* / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens