Sex-mismatched transplantation can be associated with an increased incidence of graft-versus-host disease (GVHD) and reduced survival, but new research clarifies the most likely outcomes.
Use of a female donor for a male undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) can raise the risk of chronic GVHD but did not significantly reduce survival rates, according to research presented at the Tenth Annual Meeting of the Society of Hematologic Oncology (SOHO).
The issue with this direction of sex-mismatched transplantation “is caused by the antibodies against minor histocompatibility antigens found on the Y chromosome of the male recipient, which were found to be associated with increased risk of chronic GVHD and non-relapse mortality,” Mahmoud Bokhary, MSc, of the Manchester University NHS Foundation Trust in the United Kingdom, and colleagues wrote in an abstract presented at the SOHO meeting.
The researchers performed a retrospective study over 8 years at the Nasser Institute Hospital, dividing patients into 2 groups, a group of male patients with female donors (n=245) and a group including female patients with male donors (n=186) and patients with same-sex donors (n=506). The median patient age was 20 years (range, 7 months-60 years). All donors were human leukocyte antigen-identical sibling donors.
Acute GVHD rates were slightly higher in male patients with female donors (24%) than in female patients with male donors and same-sex patients and donors (19.6%). However, chronic GVHD rates were significantly higher in male patients with female donors (15.1%) than in female patients with male donors and patients with same-sex donors (9.6%; P=.02).
The overall survival (OS) rates were similar between groups, with an OS of 68.6% in male patients with female donors and 69.5% in female patients with male donors and patients with same-sex donors. Non-relapse mortality rates were also similar between groups, with a non-relapse morality rate of 27.7% in female patients with male donors and a rate of 25.7% in female patients with male donors and patients with same-sex donors. The relapse/failure rate was slightly lower in the male patients with female donors (4.9%) than in the female patients with male donors and patients with same-sex donors (6.5%).
“Allogeneic [HSCT] for male patients from female donors can be associated with a significantly higher rate of chronic GVHD but a lower incidence of relapse/failure,” the researchers concluded.
Bokhary M, Kamel R, Fathy G, et al. Outcome of sex-mismatched allogeneic hemopoietic stem cell transplantation from human leukocyte antigen–identical sibling donors in patients with hematologic diseases. Poster CT-132. Presented at the Tenth Annual Meeting of the Society of Hematologic Oncology; September 28-October 1, 2022; Houston, TX.
