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STEM CELL TRANSPLANTATION

Improved survival with younger HLA-matched unrelated donors versus older matched sibling donor HCT with PTCy-prophylaxis

Leukemia (2024)Cite this article

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As donor age is a significant predictor of hematopoietic cell transplantation (HCT) outcomes [1, 2], a common clinical dilemma for patients with both an HLA-matched related and an unrelated donor is whether to select a “younger” matched unrelated donor (MUD) or an “older” matched sibling donor (MSD). A few prior studies compared HCT outcomes between these two donor types, taking donor age into consideration. These studies generally indicated a higher risk of graft-versus-host disease (GVHD) and non-relapse mortality (NRM) with “younger” MUD compared to “older” MSD. However, they also showed a higher risk of relapse with the MSD, resulting in similar overall survival (OS) between the groups [3,4,5]. Notably, these studies were conducted in the setting of conventional GVHD prophylaxis. Considering that GVHD is one of the leading causes of NRM [6] and the significant reduction in GVHD risk with post-transplant cyclophosphamide (PTCy) prophylaxis [7], we hypothesized that the higher NRM risk observed with “younger” MUDs in previous studies would be mitigated with the use of PTCy. Furthermore, the lower relapse risk with MUDs could potentially be associated with better OS compared to the MSD group.

To assess that, we used two publicly available CIBMTR datasets [8] from the referenced publications [9, 10]. Our study population included patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) who underwent an 8/8-HLA MUD HCT or an HLA-identical sibling donor HCT between 2011 and 2018. All patients received PTCy for GVHD prophylaxis.

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Fig. 1: Outcomes of younger MUD (blue) versus older MSD (red) HCT.

Data availability

The data are publicly available and accessible at https://cibmtr.org/CIBMTR/Resources/Publicly-Available-Datasets.

References

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  3. Alousi AM, Le-Rademacher J, Saliba RM, Appelbaum FR, Artz A, Benjamin J, et al. Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer? Blood. 2013;121:2567–73.

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Acknowledgements

We thank the CIBMTR staff for providing this dataset. The CIBMTR is supported primarily by the Public Health Service U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); 75R60222C00011 from the Health Resources and Services Administration (HRSA); N00014-21-1-2954 and N00014-23-1-2057 from the Office of Naval Research.

Funding

This dataset was collected by the Center for International Blood and Marrow Transplant Research (CIBMTR) which is supported primarily by the Public Health Service U24CA076518 from the National Cancer Institute; the National Heart, Lung, and Blood Institute; the National Institute of Allergy and Infectious Diseases; 75R60222C00011 from the Health Resources and Services Administration; N00014-21-1-2954 and N00014-23-1-2057 from the Office of Naval Research; the National Marrow Donor Program/Be The Match; and the Medical College of Wisconsin.

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Authors and Affiliations

  1. MD Anderson Cancer Center, Houston, TX, USA

    Jeremy Ramdial, Partow Kebriaei, Richard E. Champlin, Uday Popat, Katayoun Rezvani & Elizabeth J. Shpall

  2. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Rohtesh S. Mehta

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  1. Jeremy Ramdial
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Contributions

RSM conceptualized the study, performed the analysis, interpreted data, and wrote the manuscript; JR, PK, UP, REC, KR, and EJS reviewed and interpreted the data, reviewed the manuscript, and provided critical feedback. RSM had full access to the raw data which is publicly available. All authors approved the manuscript. The corresponding author had the final responsibility to submit for publication.

Corresponding author

Correspondence to Rohtesh S. Mehta.

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Ramdial, J., Kebriaei, P., Champlin, R.E. et al. Improved survival with younger HLA-matched unrelated donors versus older matched sibling donor HCT with PTCy-prophylaxis. Leukemia (2024). https://doi.org/10.1038/s41375-024-02256-0

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