Donor age and degree of HLA matching have a major impact on the outcome of unrelated donor haematopoietic cell transplantation for chronic myeloid leukaemia

Carreras, Enric; Jiménez, Mónica; Gómez-García, V.; Cámara, Rafael de la; Martín, Carmen; Martínez, Francisco García; Iriondo, A; Sanz, Guillermo; Cañizo, Consuelo del; Cabrera, Rafael; Sierra, Jorge; Vallejo, Carlos; López, Javier; Martı́nez, Carmen; Rovira, Montserrat; Fernández-Rañada, JM; Torres, Antonio

doi:10.1038/sj.bmt.1705195

Cited by 51 publications

(44 citation statements)

References 19 publications

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“…Numerous clinical studies focusing on other entities support the use of young donors. [57][58][59][60] This finding remains valid even if multivariate analysis could not confirm donor age as an independent risk factor for HCT outcome. Donor age could not figure as a further independent risk factor, as young donor age was found to be linked with the established risk factor of limited chronic GvHD (U-test: P = 0.06).…”

Section: Discussionmentioning

confidence: 71%

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Heinzelmann

Bethge²,

Beelen

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry 'DRST'. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2-and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽ 42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatmentsensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾ 55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽ 42 years should be preferred if available.

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Section: Discussionmentioning

confidence: 71%

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Heinzelmann

Bethge²,

Beelen

et al. 2016

Bone Marrow Transplant

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“…Differences are, however, not statistically significant. If new results showed that effects of donor age on transplantation success were smaller than demonstrated so far, [11][12][13][14] the preference of transplant physicians for younger donors could decline. As a result, both differences in age-specific donation probabilities and the number of donors who must be recruited to compensate for donor file aging would decrease.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, the determination of optimal donor registry size raises complex ethical questions as the value of a successful stem cell transplantation must be weighed against costs for ongoing donor recruitment or additional HLA typing of already registered donors. 10 While these issues demonstrate the difficulties of a quantitative assessment of optimal donor registry size, the fact that only 40-50% of all patients in need of a stem cell transplantation find a donor who matches for the HLA-A, -B, -C and -DRB1 loci at the allele level 12,24 suggests that efforts to increase the usefulness of the global donor pool may be indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Such preferences are in accordance with published results indicating more favorable transplantation outcomes for transplants that use younger donors. [11][12][13][14] The calculated donation probabilities provide the input for a model aimed to quantify the aging-induced reduction of donor file usefulness and to estimate the number R of donors who need to be recruited to compensate for this reduction. It shows that R exceeds the number of donors who reach the age limit considerably in both analyzed scenarios (intermediate typing of the HLA-A and -B loci versus more complete typing of new donors).…”

Section: Discussionmentioning

confidence: 99%

“…However, it may not be sufficient just to replace these donors to maintain the usefulness of a donor file since there is evidence that the outcome of hematopoietic stem cell transplantation is better for younger donors. [11][12][13][14] Therefore, even aging of those donors who are far below the age limit may lead to a decrease of donor file usefulness. We verify and quantify this effect and estimate the number of donors who have to be added annually to a given donor pool to compensate for this reduction in usefulness.…”

Section: Introductionmentioning

confidence: 99%

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Aging of registered stem cell donors: implications for donor recruitment

Schmidt

Biesinger

Baier

et al. 2007

Bone Marrow Transplant

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With more than 11 million registered stem cell donors worldwide and limited resources for health systems, it seems questionable if investments in ongoing donor recruitment are useful. Since there is evidence that transplant outcomes are better with younger donors, the age distribution of registered donors is highly relevant in this context. One might argue that the usefulness of a donor file decreases if there is no new donor recruitment not only as a result of loss of donors who reach the age limit for donation but also since those donors who remain in the file get older. We established a multivariate model to quantify this effect and to estimate the number (designated R) of donors who must be recruited annually to keep donor file usefulness constant. The model is applied to real data from DKMS German Bone Marrow Donor Center. R exceeds the number of donors who reach the age limit by factors up to 7.3. The model can serve as an easy-to-use tool for strategic donor registry planning. Our results suggest that analyses regarding optimal size of donor registries should also include the age distribution of registered donors.

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Relapse and Disease-Free Survival in Patients With Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation Using Older Matched Sibling Donors vs Younger Matched Unrelated Donors

Murthy

Kim

et al. 2022

JAMA Oncol

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IMPORTANCEMatched sibling donors (MSDs) are preferred for allogeneic hematopoietic cell transplantation (allo-HCT) in myelodysplastic syndrome even if they are older. However, whether older MSDs or younger human leukocyte antigen-matched unrelated donors (MUDs) are associated with better outcomes remains unclear.OBJECTIVE To investigate whether allo-HCT for myelodysplastic syndrome using younger MUDs would be associated with improved disease-free survival and less relapse compared with older MSDs. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study assessed data reported to the Center for International Blood and Marrow Transplant Research database from 1761 adults 50 years or older with myelodysplastic syndrome who underwent allo-HCT using an

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Donor age and degree of HLA matching have a major impact on the outcome of unrelated donor haematopoietic cell transplantation for chronic myeloid leukaemia

Cited by 51 publications

References 19 publications

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Allogeneic hematopoietic cell transplantation as curative therapy for non-transformed follicular lymphomas

Aging of registered stem cell donors: implications for donor recruitment

Relapse and Disease-Free Survival in Patients With Myelodysplastic Syndrome Undergoing Allogeneic Hematopoietic Cell Transplantation Using Older Matched Sibling Donors vs Younger Matched Unrelated Donors

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