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

• Published in: British journal of haematology 2020-04, Vol.189 (1), p.153-161
• Main Authors: Wang, Yu, Liu, Qi‐Fa, Wu, De‐Pei, Xu, Lan‐Ping, Liu, Kai‐Yan, Zhang, Xiao‐Hui, Lu, Sheng‐Ye, Ma, Xiao, Huang, Fen, Huang, Xiao‐Jun
• Format: Article
• Language: English
• Subjects: donor age; donor selection; Graft-versus-host reaction; haploidentical; Hematology; Histocompatibility antigen HLA; Leukemia; matched sibling; Offspring; older age; Remission
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1111/bjh.16303

Summary Donor selection for older leukaemia patients undergoing haematopoietic cell transplant (HCT) is not well defined: outcomes might be improved with a younger offspring donor rather than an older human leukocyte antigen (HLA)‐matched sibling donor (MSD). We extended our multicentre dataset. A total of 185 acute leukaemia patients (≥ 50 years) transplanted in first complete remission who received HCT from offspring (n = 62) or MSD (n = 123) were included. A 1:1 ratio matched‐pair analysis was performed. We were able to match 54 offspring with 54 MSD patients. Outcomes were compared between the two matched‐pair groups. The cumulative incidence of grade II/IV acute graft‐versus‐host disease (GVHD) (26% vs. 35%; P = 0·23) and chronic GVHD (37% vs. 24%; P = 0·19) was comparable between groups (MSD vs. offspring). The lower three‐year transplant‐related mortality (9% vs. 26%; P = 0·023) and relapse incidence (6% vs. 17%; P = 0·066) resulted in higher overall survival (85% vs. 58%; P = 0·003) and leukaemia‐free survival (LFS) (85% vs. 56%; P = 0·001) in offspring HCT compared with that in MSD HCT. These data might favour a young offspring over an older MSD in patients >50 years. The current analyses confirm that non‐HLA donor characteristics, such as kinship and donor age, rather than HLA disparity, predominantly influence survival in older acute leukaemia patients.