High non-relapse mortality and low relapse incidence in gender-mismatched allogeneic hematopoietic stem cell transplantation from a parous female donor with a male child

Shinohara, Akihito; Inamoto, Yoshihiro; Kurosawa, Saiko; Hiramoto, Nobuhiro; Ueda, Ryosuke; Tanaka, Takashi; Tada, Kohei; Kobayashi, Yohnosuke; Morikawa, Noriyuki; Okinaka, Keiji; Kim, Sung-Won; Tajima, Kinuko; Fukuda, Takahiro

doi:10.1080/10428194.2016.1205743

Cited by 4 publications

(2 citation statements)

References 23 publications

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“…In accordance to current consensus partially, HSCT using a female donor resulted in a remarkably lower relapse rate but higher survival rate in this study. Several studies had concluded that the use of a female donor, especially when the recipient is a male, was associated with reduced relapse rates [ 5 , 32 – 34 ]. First, the major explanation for the lower relapse rates would be the inherent information variance caused by sex chromosomes.…”

Section: Discussionmentioning

confidence: 99%

Salvaged allogeneic hematopoietic stem cell transplantation for pediatric chemotherapy refractory acute leukemia

et al. 2017

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There is an ongoing debate concerning the performance of salvaged allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pediatric patients with acute refractory leukemia, in whom the prognosis is quite dismal. Few studies have ever been conducted on this subject. This may be partly due to missed opportunities by majority of the patients in such situations. To investigate the feasibility, evaluate the efficiency, and identify the prognostic factors of allo-HSCT in this sub-setting, the authors performed a single institution-based retrospective analysis. A total of 44 patients, of whom 28 had acute myeloid leukemia (AML), 13 had acute lymphocytic leukemia (ALL), and 3 had mixed phenotype leukemia (MPL), were enrolled in this study. With a median follow-up of 19 months, the estimated 2-year overall survival (OS) and progression free survival (PFS) were 34.3% (95% CI, 17.9–51.4%) and 33.6% (95% CI, 18.0–50.1%), respectively. The estimated 2-year incidence rates of relapse and non-relapse mortality (NRM) were 43.8% (95% CI 26.4–60.0%) and 19.6% (95% CI 9.1–32.9%), respectively. The estimated 100-day cumulative incidence of acute graft versus host disease (aGvHD) was 43.6% (95% CI 28.7–57.5%), and the 1-year cumulative incidence of chronic GvHD (cGvHD) was 45.5% (95% CI 30.5–59.3%). Compared with the previous studies, the multivariate analysis in this study additionally identified that female donors and cGvHD were associated with lower relapse and better PFS and OS. Male recipients, age younger than 10 years, a diagnosis of ALL, and the intermediate-adverse cytogenetic risk group were associated with increased relapse. On the contrary, extramedullary disease (EMD) and aGvHD were only linked to worse PFS. These data suggested that although only one-third of the patients would obtain PFS over 2 years, salvaged allo-HSCT is still the most reliable and best therapeutic strategy for refractory pediatric acute leukemia. If probable, choosing a female donor, better management of aGvHD, and induction of cGvHD promotes patient survival.

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Section: Discussionmentioning

confidence: 99%

Salvaged allogeneic hematopoietic stem cell transplantation for pediatric chemotherapy refractory acute leukemia

et al. 2017

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“…Non-relapse mortality in male patients receiving a haematopoietic stem cell transplantation from a female donor was associated with pregnancy history of the female donor, and particularly with a prior pregnancy with a male child [33]. During pregnancy, there is exchange of fetal and maternal cells across the placenta [34][35][36].…”

Section: Donor Sex and Pregnancy In Haematopoietic Stem Cell Transpla...mentioning

confidence: 99%

Donor sex and recipient outcomes

Valk

Caram‐Deelder

Zwaginga

et al. 2019

ISBT Science Series

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Donor characteristics, such as donor sex and age, have been implicated in adverse outcomes following red blood cell transfusions. There is a vast body of evidence supporting a role for sex mismatch in solid organ and stem cell transplantation. Most of these findings suggest the strongest effect of sex mismatch between multiparous female donors and male recipients. In this review, we discuss the available evidence from transfusion, solid organ transplantation and stem cell transplantation medicine. We suggest several possible biological mechanisms behind the association of donor pregnancy and transfusion recipient mortality that can be further investigated in future research. Foremost, we claim donor microchimeric cell‐mediated immune modulation is the most likely explanation for the observed associations in transfusion medicine.

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Long‐term outcome of 2‐year survivors after allogeneic hematopoietic cell transplantation for acute leukemia

Larue,

Labopin,

Schroeder

et al. 2024

HemaSphere

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Information on late complications in patients with acute leukemia who have undergone allogeneic hematopoietic cell transplantation (HCT) is limited. We performed a left‐truncated analysis of long‐term survival in patients with acute leukemia who were alive and disease‐free 2 years after HCT. We included 2701 patients with acute lymphoblastic leukemia (ALL) and 9027 patients with acute myeloid leukemia (AML) who underwent HCT between 2005 and 2012. The 10‐year overall survival (OS) rate was 81.3% for ALL and 76.2% for AML, with the main causes of late mortality being relapse (ALL‐33.9%, AML‐44.9%) and chronic graft‐versus‐host disease (ALL‐29%, AML‐18%). At 10 years, HCT‐related mortality was 16.8% and 20.4%, respectively. Older age and unrelated donor transplantation were associated with a worse prognosis for both types of leukemia. In addition, transplantation in the second or third complete remission and peripheral blood HSC for ALL are associated with worse outcomes. Similarly, adverse cytogenetics, female donor to male patient combination, and reduced intensity conditioning in AML contribute to poor prognosis. We conclude that 2‐year survival in remission after HCT for acute leukemia is encouraging, with OS of nearly 80% at 10 years. However, the long‐term mortality risk of HCT survivors remains significantly higher than that of the age‐matched general population. These findings underscore the importance of tailoring transplantation strategies to improve long‐term outcomes in patients with acute leukemia undergoing HCT.

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High non-relapse mortality and low relapse incidence in gender-mismatched allogeneic hematopoietic stem cell transplantation from a parous female donor with a male child

Cited by 4 publications

References 23 publications

Salvaged allogeneic hematopoietic stem cell transplantation for pediatric chemotherapy refractory acute leukemia

Salvaged allogeneic hematopoietic stem cell transplantation for pediatric chemotherapy refractory acute leukemia

Donor sex and recipient outcomes

Long‐term outcome of 2‐year survivors after allogeneic hematopoietic cell transplantation for acute leukemia

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