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Improved survival after offspring donor transplant compared with older aged-matched siblings for older leukaemia

Yu Wang1,2, Qi-Fa Liu3, De-Pei Wu4,2

  • 1Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.

British Journal of Haematology
|November 8, 2019
PubMed

Insights

For older leukemia patients, using a younger offspring donor for hematopoietic cell transplant (HCT) significantly improves survival compared to an older matched sibling donor (MSD). Offspring donors lead to better overall and leukemia-free survival with lower transplant-related mortality.

Area of Science:

  • Hematology
  • Oncology
  • Transplant Immunology

Background:

  • Donor selection for hematopoietic cell transplant (HCT) in older acute leukemia patients (≥50 years) is not well-defined.
  • Outcomes may differ based on donor type, with potential advantages for younger offspring donors over older human leukocyte antigen (HLA)-matched sibling donors (MSD).

Purpose of the Study:

  • To compare outcomes of HCT in older acute leukemia patients receiving grafts from offspring donors versus HLA-matched sibling donors.
  • To determine if donor characteristics beyond HLA matching, such as age and kinship, influence transplant success.

Main Methods:

  • A multicenter dataset of 185 acute leukemia patients (≥50 years) transplanted in first complete remission was analyzed.
  • A 1:1 matched-pair analysis compared outcomes between 54 patients receiving HCT from offspring donors and 54 matched patients receiving HCT from MSDs.
  • Key outcomes assessed included graft-versus-host disease (GVHD), transplant-related mortality, relapse incidence, overall survival, and leukemia-free survival (LFS).

Main Results:

  • Graft-versus-host disease incidence was comparable between offspring and MSD groups (acute: 26% vs. 35%; chronic: 37% vs. 24%).
  • Offspring HCT demonstrated significantly lower 3-year transplant-related mortality (9% vs. 26%; P=0.023) and higher overall survival (85% vs. 58%; P=0.003) and LFS (85% vs. 56%; P=0.001) compared to MSD HCT.
  • Relapse incidence was lower with offspring donors (6% vs. 17%; P=0.066).

Conclusions:

  • Younger offspring donors may be favored over older MSDs for HCT in patients over 50 years old with acute leukemia.
  • Non-HLA donor characteristics, including kinship and donor age, appear to be predominant factors influencing survival in this patient population.
  • These findings suggest a re-evaluation of donor selection criteria for older leukemia patients undergoing HCT.

Keywords:
donor agedonor selectionhaploidenticalmatched siblingolder age

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