TY - JOUR
T1 - Impact of donor age and kinship on clinical outcomes after T-cell-replete haploidentical transplantation with PT-Cy
AU - Mariotti, Jacopo
AU - Raiola, Anna Maria
AU - Evangelista, Andrea
AU - Carella, Angelo Michele
AU - Martino, Massimo
AU - Patriarca, Francesca
AU - Risitano, Antonio
AU - Bramanti, Stefania
AU - Busca, Alessandro
AU - Giaccone, Luisa
AU - Brunello, Lucia
AU - Merla, Emanuela
AU - Savino, Lucia
AU - Loteta, Barbara
AU - Console, Giuseppe
AU - Fanin, Renato
AU - Sperotto, Alessandra
AU - Marano, Luana
AU - Marotta, Serena
AU - Frieri, Camilla
AU - Sica, Simona
AU - Chiusolo, Patrizia
AU - Harbi, Samia
AU - Furst, Sabine
AU - Santoro, Armando
AU - Bacigalupo, Andrea
AU - Blaise, Didier
AU - Angelucci, Emanuele
AU - Mavilio, Domenico
AU - Castagna, Luca
AU - Bruno, Benedetto
PY - 2020/8/25
Y1 - 2020/8/25
N2 - 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.
AB - 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.
U2 - 10.1182/bloodadvances.2020001620
DO - 10.1182/bloodadvances.2020001620
M3 - Article
VL - 4
SP - 3900
EP - 3912
JO - Blood Adv.
JF - Blood Adv.
SN - 2473-9529
IS - 16
ER -