Impact of donor age and kinship on clinical outcomes after T-cell-replete haploidentical transplantation with PT-Cy

Jacopo Mariotti, Anna Maria Raiola, Andrea Evangelista, Angelo Michele Carella, Massimo Martino, Francesca Patriarca, Antonio Risitano, Stefania Bramanti, Alessandro Busca, Luisa Giaccone, Lucia Brunello, Emanuela Merla, Lucia Savino, Barbara Loteta, Giuseppe Console, Renato Fanin, Alessandra Sperotto, Luana Marano, Serena Marotta, Camilla FrieriSimona Sica, Patrizia Chiusolo, Samia Harbi, Sabine Furst, Armando Santoro, Andrea Bacigalupo, Didier Blaise, Emanuele Angelucci, Domenico Mavilio, Luca Castagna, Benedetto Bruno

Research output: Contribution to journalArticlepeer-review

Abstract

Donor selection contributes to improve clinical outcomes of T-cell-replete haploidentical stem cell transplantation (haplo-SCT) with posttransplant cyclophosphamide (PT-Cy). The impact of donor age and other non-HLA donor characteristics remains a matter of debate. We performed a multicenter retrospective analysis on 990 haplo-SCTs with PT-Cy. By multivariable analysis, after adjusting for donor/recipient kinship, increasing donor age and peripheral blood stem cell graft were associated with a higher risk of grade 2 to 4 acute graft-versus-host-disease (aGVHD), whereas 2-year cumulative incidence of moderate-tosevere chronic GVHD was higher for transplants from female donors into male recipients and after myeloablative conditioning. Increasing donor age was associated with a trend for higher nonrelapse mortality (NRM) (hazard ratio [HR], 1.05; P 5 .057) but with a significant reduced risk of disease relapse (HR, 0.92; P 5 .001) and improved progressionfree survival (PFS) (HR, 0.97; P 5 .036). Increasing recipient age was a predictor of worse overall survival (OS). Risk of relapse was higher (HR, 1.39; P , .001) in patients aged #40 years receiving a transplant from a parent as compared with a sibling. Moreover, OS and PFS were lower when the donor was the mother rather than the father. Pretransplant active disease status was an invariably independent predictor of worse clinical outcomes, while recipient positive cytomegalovirus serostatus and hematopoietic cell transplant comorbidity index .3 were associated with worse OS and PFS. Our results suggest that younger donors may reduce the incidence of aGVHD and NRM, though at higher risk of relapse. A parent donor, particularly the mother, is not recommended in recipients #40 years.

Original languageEnglish
Pages (from-to)3900-3912
Number of pages13
JournalBlood advances
Volume4
Issue number16
DOIs
Publication statusPublished - Aug 25 2020

ASJC Scopus subject areas

  • Hematology

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