Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Whether older HLA-matched sibling donors (MSD) are preferred over younger alternative donors for allogeneic hematopoietic cell transplantation (allo-HCT) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is unclear. We compared outcomes in allo-HCT recipients ≥50 years old after HCT from an older MSD (≥50 years) with recipients of younger (≤35 years) HLA-matched unrelated donor (MUD), haploidentical related donor (haplo), and HLA-mismatched unrelated donor (MMUD), grouped based on PTCy or calcineurin-inhibitor (CNI) based GVHD prophylaxis, that were reported to the Center for International Blood and Marrow Transplant Research between 2014 and 2021. The primary end point was overall survival (OS). Among 14 662 HCT recipients, 3746 received PTCy- and 10 916 CNI-based prophylaxis. In patients receiving PTCy-based HCT, the adjusted 5-year OS was similar between MSD and other donor types: 44% after MSD versus 52% after MUD (multivariable hazard ratio [HR]: 1.20; 95% confidence interval [CI], 1.03-1.41; P = .09), 45% after haplo donor (HR, 1.02; 95% CI, 0.88-1.18; P = 1.00), and 46% after MMUD (HR, 1.00; 95% CI, 0.83-1.21; P = 1.00). Compared with MSD, use of MUD associated with improved disease-free survival (DFS) with PTCy-based (HR, 1.21; 95% CI, 1.05-1.40; P = .048) and CNI-based (HR, 1.09; 95% CI, 1.04-1.15; P < .01) prophylaxis. Haplo donor use associated with worse OS compared with MUD use with PTCy (HR, 1.18; 95% CI, 1.05-1.33; P = .04). Older MSDs result in similar OS compared with younger alternative donors; however, use of a younger MUD associated with improved DFS in older-aged recipients.
Source: Blood Advances
Authors: Karthik Nath, Mei-Jie Zhang, Matthew Bye, Muhammad Bilal Abid, Cara Benjamin, Brian Betts, Neel S. Bhatt, Esteban Arrieta Bolaños, Yung-Tsi Bolon, Shahinaz M. Gadalla, Michael R. Grunwald, Maxwell M. Krem, Stephanie J. Lee, Steven G. E. Marsh, Rodrigo Martino, Parinda A. Mehta, Filippo Milano, Timothy Prestidge, Jennifer N. Saultz, Bronwen E. Shaw, Stephen R. Spellman, Hannah Choe, Brian C. Shaffer
Institutions: Memorial Sloan Kettering Cancer Center, Icon (Australia), Medical College of Wisconsin, University of Miami, Sylvester Comprehensive Cancer Center, Roswell Park Comprehensive Cancer Center, University of Washington, Fred Hutch Cancer Center, Essen University Hospital, National Marrow Donor Program, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Levine Cancer Institute, Kansas City VA Medical Center, The Royal Free Hospital, University College London, Hospital de Sant Pau, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Starship Children's Health, Oregon Health & Science University, The Ohio State University Wexner Medical Center, The Ohio State University
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
Funders: Gateway for Cancer Research, Amgen, Bristol-Myers Squibb, Pfizer, Astellas Pharma US, AstraZeneca, Sanofi, Gilead Sciences, Alexion Pharmaceuticals, HistoGenetics, Novartis Pharmaceuticals Corporation, CSL Behring, Actinium Pharmaceuticals, Vertex Pharmaceuticals, Jazz Pharmaceuticals, Mallinckrodt Pharmaceuticals, Atara Biotherapeutics, CareDx, bluebird bio, Adaptive Biotechnologies, BeiGene, Incyte, Omeros Corporation, Seagen, Kiadis Pharma, Astellas Pharma, Swedish Orphan Biovitrum, MorphoSys, Medac, National Institutes of Health, Health Resources and Services Administration, Takeda Oncology, Pharmacyclics, Legend Biotech, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases, National Institute of Environmental Health Sciences, Janssen Research and Development
Awards: G1387388519, G1790975258, G1897780449, G2026547544, G2551907125, G2883373350, G3000610264, G4102770861, G4805940643, G5464719372, G5595967893, G6516949535, G6538849774, G7698102948, G8876996369, G9000003249, Cancer Center Support Grant, A Data Resource for Blood and Marrow Transplants and Adoptive Cellular Therapy Research, Targeting epigenetic regulation via Bromodomain and Extraterminal (BET) domain inhibition for treatment of GVHD
OpenAlex ID: W4408246537