Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer?

Publication Type:

Journal Article

Source:

Blood (2013)

Keywords:

Clinical Research Division, February 2013

Abstract:

Older patients are increasingly undergoing allogeneic hematopoietic transplants. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/ lymphoma patients aged ≥50 years were analyzed comparing outcomes for recipients of MSD ≥50 versus MUD < 50 years. 1,415 cases had a MSD aged ≥50 years; 757 had a MUD aged < 50 years. Risks of acute graft-versus-host disease (GVHD) grade 2-4 (HR 1.63; p<0.001), 3-4 (HR 1.85; p<0.001) and chronic GVHD (HR 1.48; p<0.0001) were higher after MUD compared to MSD transplants. The effect of donor type on non-relapse mortality (NRM), relapse and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR 1.42; p=0.001), relapse (HR 1.45; p<0.001) and overall mortality (HR 1.28; p=0.001) risks were higher after MUD compared to MSD transplants. For patients with scores less than 90, NRM (HR 0.96; p=0.76), relapse (HR 0.86, p=0.25) and overall mortality (HR 0.90, p=0.29) were not significantly different after MUD and MSD transplants. These data favor a MSD over a MUD in patients aged ≥50 years and older.