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Optimizing Haploidentical Donor Selection for Pediatric Hematopoietic Cell Transplant.

Nicole Liberio1, Mariam Allbee-Johnson2, Kwang Woo Ahn2,3

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Younger haploidentical donors (<18 years) reduce graft-versus-host disease (GVHD) risk in pediatric hematopoietic cell transplants. Sibling donors are preferred over parental donors, especially mothers, to minimize acute and chronic GVHD.

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Area of Science:

  • Hematology
  • Immunology
  • Pediatric Oncology

Background:

  • Selecting haploidentical donors for pediatric hematopoietic cell transplants requires critical guidance.
  • The impact of donor relationship (parent, sibling, extended family) on graft-versus-host disease (GVHD) outcomes is not fully understood.

Purpose of the Study:

  • To evaluate the effect of donor age and relationship on acute (aGVHD) and chronic (cGVHD) graft-versus-host disease in pediatric patients.
  • To provide guidance on optimal donor selection for pediatric haploidentical stem cell transplantation.

Main Methods:

  • Analysis of 1,069 pediatric recipients (<19 years) undergoing hematopoietic cell transplant between 2013-2019.
  • Assessment of primary endpoints: aGVHD frequency at 100 days and cumulative incidence of cGVHD at 2 years.
  • Multivariable analysis considering donor age (<18, 18-35, >35 years) and donor relationship (parental, sibling).

Main Results:

  • Younger donors (<18 years) were associated with significantly lower rates of both aGVHD and cGVHD compared to older donors.
  • Parental donors, particularly mothers, were linked to a higher risk of aGVHD and cGVHD compared to sibling donors.
  • Maternal donors showed increased GVHD risk irrespective of age, with higher rates of aGVHD and cGVHD compared to sibling donors.

Conclusions:

  • Donors under 18 years are associated with reduced aGVHD and cGVHD in pediatric haploidentical transplants.
  • Maternal donors are associated with an increased risk of cGVHD.
  • Sibling donors should be prioritized for pediatric patients to minimize GVHD risk.