Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis

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.

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Publication Details

Journal
Blood Advances
Published
2025-03-06
DOI
https://doi.org/10.1182/bloodadvances.2024014858
Citations
10
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
Field-Weighted Citation Impact
17.70

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article

Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis

Tim D. Prestidge, Cara L. Benjamin, Matthew Bye, Esteban Arrieta‐Bolaños et al.
10 citations
Blood Advances
Hematopoietic Stem Cell Transplantation
17.70
article

Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis

Tim D. Prestidge, Cara L. Benjamin, Matthew Bye, Esteban Arrieta‐Bolaños, Steven G. E. Marsh, Rodrigo Martino, Stephanie J. Lee, Bronwen E. Shaw, Hannah Choe, Brian C. Betts, Karthik Nath, Michael R. Grunwald, Jennifer N. Saultz, Neel S. Bhatt, Yung‐Tsi Bolon, Muhammad Bilal Abid, Filippo Milano, Brian C. Shaffer, Stephen R. Spellman, Shahinaz M. Gadalla, Maxwell M. Krem, Mei‐Jie Zhang, Parinda A. Mehta
article en
10 citations

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.

Blood AdvancesVol. 9(14)
Cincinnati Children's Hospital Medical Center (US), Roswell Park Comprehensive Cancer Center (US), National Marrow Donor Program (US), Memorial Sloan Kettering Cancer Center (US), University of Miami (US), Oregon Health & Science University (US), Cancer Council Queensland (AU), University of Washington (US), Medical College of Wisconsin (US), Anthony Nolan (GB), Hospital de Sant Pau (ES), The Ohio State University Wexner Medical Center (US), Fred Hutch Cancer Center (US), Levine Cancer Institute (US), Essen University Hospital (DE), National Cancer Institute (UA), National Cancer Institute (US), Starship Children's Health (NZ), CRUK Lung Cancer Centre of Excellence (GB), Kansas City VA Medical Center (US), Sylvester Comprehensive Cancer Center (US), Department of Health and Human Services (US), Immune Deficiency Foundation (US), University College London (GB), The Ohio State University (US), University of Cincinnati (US)
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, Janssen Research and Development
Good health and well-being
Openalex Percentile: Top 1%
Hematopoietic Stem Cell Transplantation
17.70
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