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Br J Haematol. 2019 Nov 7. doi: 10.1111/bjh.16303. [Epub ahead of print]

Improved survival after offspring donor transplant compared with older aged-matched siblings for older leukaemia patients.

Author information

1
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
2
Collaborative Innovation Center hematology, Soochow University, Suzhou, China.
3
Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, Beijing.
4
The first affiliated hospital of Soochow University, Suzhou, Jiangsu, China.
5
Peking-Tsinghua Center for Life Sciences, Beijing, China.
6
Collaborative Innovation Center hematology, Peking University, Beijing, China.

Abstract

Donor selection for older leukaemia patients undergoing haematopoietic cell transplant (HCT) is not well defined: outcomes might be improved with a younger offspring donor rather than an older human leukocyte antigen (HLA)-matched sibling donor (MSD). We extended our multicentre dataset. A total of 185 acute leukaemia patients (≥ 50 years) transplanted in first complete remission who received HCT from offspring (n = 62) or MSD (n = 123) were included. A 1:1 ratio matched-pair analysis was performed. We were able to match 54 offspring with 54 MSD patients. Outcomes were compared between the two matched-pair groups. The cumulative incidence of grade II/IV acute graft-versus-host disease (GVHD) (26% vs. 35%; P = 0·23) and chronic GVHD (37% vs. 24%; P = 0·19) was comparable between groups (MSD vs. offspring). The lower three-year transplant-related mortality (9% vs. 26%; P = 0·023) and relapse incidence (6% vs. 17%; P = 0·066) resulted in higher overall survival (85% vs. 58%; P = 0·003) and leukaemia-free survival (LFS) (85% vs. 56%; P = 0·001) in offspring HCT compared with that in MSD HCT. These data might favour a young offspring over an older MSD in patients >50 years. The current analyses confirm that non-HLA donor characteristics, such as kinship and donor age, rather than HLA disparity, predominantly influence survival in older acute leukaemia patients.

KEYWORDS:

donor age; donor selection; haploidentical; matched sibling; older age

PMID:
31696939
DOI:
10.1111/bjh.16303

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