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Sanz J, Labopin M, Choi G, Kulagin A, Peccatori J, Vydra J, Remenyi PP, Versluis J, Rovira M, Blaise D, Labussiere-Wallet H, Montoro J, Sica S, Meijer E, Itälä-Remes M, Schaap N, Bulabois CE, Piemontese S, Mohty M, Ciceri F. Younger unrelated donors may be preferable over HLA match in the PTCy era: A study from the ALWP of the EBMT. Blood 2024:blood.2023023697. [PMID: 38657278 DOI: 10.1182/blood.2023023697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 04/26/2024] Open
Abstract
There is a paucity of information on how to select the most appropriate unrelated donor (UD) in hematopoietic stem cell transplant (HSCT) using post-transplant cyclophosphamide (PTCy). We retrospectively analyzed the characteristics of 10/10 matched unrelated donors (MUD) and 9/10 mismatched unrelated donors (MMUD) that may affect transplant outcomes in patients with acute myeloid leukemia (AML) in first or second complete remission (CR1 or CR2). The primary endpoint was leukemia-free survival (LFS). Overall, 1011 patients were included with a median age of 54 years (range, 18-77). Donors had a median age of 29 years (range, 18-64); 304 (30%) were females of which 150 (15% of whole group) were donors to male recipients, and 621 (61%) were MUDs; 522 (52%) had negative cytomegalovirus (CMV-neg) serostatus of which 189 (19%) were used for CMV-neg recipients. Donor age older than 30 years had a negative impact on relapse (HR 1.38; 95% CI 1.06-1.8), LFS (HR 1.4; 95% CI 1.12-1.74), overall survival (HR 1.45; 95% CI 1.14-1.85) and GVHD-free, relapse-free survival (HR 1.29; 95% CI 1.07-1.56). Additionally, CMV-neg donor for CMV-neg recipient was associated with improved LFS (HR 0.74; 95% CI 0.55-0.99). The use of MMUD and female donors for male recipients did not significantly impact any transplant outcomes. For patients undergoing HSCT from an UD with PTCy for AML, donor age < 30 years significantly improves survival. In this context, donor age might be prioritized over HLA match considerations. In addition, CMV neg donors are preferable for CMV neg recipients. However, further research is needed to validate and refine these recommendations.
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Affiliation(s)
- Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Goda Choi
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | - Montserrat Rovira
- Hospital Clinic Barcelona, Institute of Hematology & Oncology, Barcelona, Spain
| | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, France
| | - Helene Labussiere-Wallet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, PIERRE BENITE Cedex, France
| | - Juan Montoro
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Ellen Meijer
- Amsterdam UMC, location VU medical center, Amsterdam, Netherlands
| | | | - Nicolaas Schaap
- Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
| | | | | | - Mohamad Mohty
- Hôpital Saint-Antoine, INSERM UMRs 938, and Université Sorbonne, Paris, France
| | - Fabio Ciceri
- San Raffaele Scientific Institute, Milano, Italy
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