Donor Age Affects Haploidentical or Matched Unrelated Selection for Donor Type

By Dustin Samples - Last Updated: December 11, 2022

According to a new report, donor age can significantly affect the outcomes for hematopoietic cell transplantation (HCT). The results were presented at the 64th American Society of Hematology Annual Meeting and Exposition.

The report, published by lead author Leonardo Javier Arcuri of the Hospital Albert Einstein in Sao Paolo, Brazil, and his team, retrospectively reviewed the Center for International Blood and Marrow Transplant Research dataset published by Gooptu et al (Blood 2021). The authors reviewed outcomes for 2 opposing groups—haploidentical (haplo) donors and matched unrelated donors (MUDs)—at 2 different age ranges (<35 years vs ≥35 years).

First, the authors compared outcomes of HCT from haplo donors ≥35 years of age with those of MUDs <35 years of age.

Second, they did the opposite, comparing outcomes of HCT from haplo donors <35 years of age with those of MUDs ≥35 years of age.

The outcomes of interest were overall survival (OS), relapse rate (REL), nonrelapse mortality (NRM), grade II-IV acute graft-versus-host disease (aGVHD), and chronic GVHD.

For the first comparison, the authors found that OS, NRM, grade II-IV aGVHD, and chronic GVHD were all improved in the MUD group. REL was the same between the 2 groups.

For the second comparison, the authors found that OS, REL, and NRM were the same between groups. Grade II-IV aGVHD was different between the groups but not significantly (hazard ratio, 1.10; P=.67 for MUD vs haplo). Of note, there was a slightly (though not significantly) lower risk of chronic GVHD in the MUD group.

Based on their results, the authors concluded that “a young MUD should be prioritized over an older haplo donor. However, when an older MUD and a younger haplo donor are available, the results are comparable, and prioritization should take other factors [into] account, like [cytomegalovirus], ABO match, donor weight, and logistics.”

Arcuri LJ, de Souza Santos FP, Kerbauy L, Kerbauy MN, Ribeiro AF, Hamerschlak N. Impact of donor age in the selection of a haploidentical or a matched-related donor: a secondary analysis of a CIBMTR database. Abstract #2080. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, LA.

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