Donor age as a dual‐risk factor for donor safety and recipient survival in allogeneic haematopoietic stem cell transplantation

Donor selection in allogeneic haematopoietic stem cell transplantation (allo-HSCT) requires balancing donor safety and recipient survival. We aimed to identify dual-association donor factors (DADFs)-donor characteristics associated with both increased serious adverse events (SAEs) and inferior patient survival-using umbilical cord blood (UCB) as a donor-safety benchmark. This nationwide retrospective cohort study analysed Japanese registry data (2013-2022) including 22 892 donors and 29 559 recipients. Logistic regression identified donor SAE risk factors, while patient outcomes were evaluated using inverse probability of treatment weighting (IPTW)-adjusted Cox models with UCB as reference. Propensity score matching (PSM) compared UCB with older donor haploidentical transplantation using post-transplant cyclophosphamide (OD-PTCy-Haplo). Among donors, 93 (0.41%) experienced an SAE. Older donor age and female sex were independent risk factors for SAE. In IPTW-adjusted analyses, allo-HSCT from older haploidentical donors was associated with inferior overall survival (OS) and relapse-free survival (RFS) compared with UCB. In PSM analyses of elderly high-risk recipients, OD-PTCy-Haplo resulted in significantly worse OS and RFS than UCB. Older donor age emerged as a donor characteristic associated with increased donor SAE risk and inferior patient survival, particularly in haploidentical transplantation. UCB may offer a more favourable balance between donor safety and patient outcomes in selected high-risk settings.

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Publication Details

Journal
British Journal of Haematology
Published
2026-07-26
DOI
https://doi.org/10.1111/bjh.70707
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
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article

Donor age as a dual‐risk factor for donor safety and recipient survival in allogeneic haematopoietic stem cell transplantation

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Fumiya Wada et al.
British Journal of Haematology
Hematopoietic Stem Cell Transplantation
article

Donor age as a dual‐risk factor for donor safety and recipient survival in allogeneic haematopoietic stem cell transplantation

Masatsugu Tanaka, Naoyuki Uchida, Yoshinobu Kanda, Fumiya Wada, Yuta Hasegawa, Koichi Miyamura, Noboru Asada, Ryu Yanagisawa, Takashi Nagayama, Noriko Doki, Yoshiko Atsuta, Hideki Nakasone, Toshiro Kawakita, Koji Kato, Kazuhiko Ikeda, Y Kodera, T Nishida, Junya Kanda, Satoshi Nishiwaki, Shingo Yano, Yasuo Morishima, Moeko Hino, M Sawa, Jun Ishikawa, Ken Tabuchi, Takahiro Fukuda, Tetsuya Eto
article en

Abstract

Donor selection in allogeneic haematopoietic stem cell transplantation (allo-HSCT) requires balancing donor safety and recipient survival. We aimed to identify dual-association donor factors (DADFs)-donor characteristics associated with both increased serious adverse events (SAEs) and inferior patient survival-using umbilical cord blood (UCB) as a donor-safety benchmark. This nationwide retrospective cohort study analysed Japanese registry data (2013-2022) including 22 892 donors and 29 559 recipients. Logistic regression identified donor SAE risk factors, while patient outcomes were evaluated using inverse probability of treatment weighting (IPTW)-adjusted Cox models with UCB as reference. Propensity score matching (PSM) compared UCB with older donor haploidentical transplantation using post-transplant cyclophosphamide (OD-PTCy-Haplo). Among donors, 93 (0.41%) experienced an SAE. Older donor age and female sex were independent risk factors for SAE. In IPTW-adjusted analyses, allo-HSCT from older haploidentical donors was associated with inferior overall survival (OS) and relapse-free survival (RFS) compared with UCB. In PSM analyses of elderly high-risk recipients, OD-PTCy-Haplo resulted in significantly worse OS and RFS than UCB. Older donor age emerged as a donor characteristic associated with increased donor SAE risk and inferior patient survival, particularly in haploidentical transplantation. UCB may offer a more favourable balance between donor safety and patient outcomes in selected high-risk settings.

British Journal of Haematology
Jikei University School of Medicine (JP), Fukushima Medical University (JP), Jichi Medical University (JP), Chiba University (JP), Aichi Medical University (JP), Kyoto University (JP), Kanagawa Prefectural Hospital Organization (JP), Tokyo Metropolitan Komagome Hospital (JP), Kurashiki Central Hospital (JP), Nagoya University Hospital (JP), Aichi Medical University Hospital (JP), Hamanomachi Hospital (JP), Okayama University Hospital (JP), Shinshu University Hospital (JP), Japanese Red Cross Nagoya Daiichi Hospital (JP), Hokkaido University Hospital (JP), Anjo Kosei Hospital (JP), Osaka International Cancer Institute (JP), The Japanese Data Center for Hematopoietic Cell Transplantation (JP), Kumamoto Medical Center (JP), Jichi Medical University Saitama Medical Center (JP), Toranomon Hospital (JP), Kanagawa Cancer Center, Bank of Japan (JP)
Good health and well-being
Openalex Percentile: Top 9%
Hematopoietic Stem Cell Transplantation
DOISourceOpenAlex
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