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

Alousi, Amin M.; Le‐Rademacher, Jennifer; Saliba, Rima M.; Appelbaum, Frederick R.; Artz, Andrew S.; Benjamin, Jonathan; Devine, Steven M.; Kan, Fangyu; Laughlin, Mary J.; Lazarus, Hillard M.; Liesveld, Jane L.; Perales, Miguel Angel; Maziarz, Richard T.; Sabloff, Mitchell; Waller, Edmund K.; Eapen, Mary; Champlin, Richard E.

doi:10.1182/blood-2012-08-453860

Cited by 119 publications

(76 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alousi et al reported that unrelated allo-HSCT were associated with higher incidences of GvHD and NRM in patients older than 50 years of age. 25 In line with these data, we previously reported a 1-year NRM of 24% using the similar Flu-Bu-ATG platform in patients over 55 years of age receiving allo-HSCT from an unrelated donor compared to 9% in this present series. 26 Advanced diseases remain a major concern.…”

supporting

confidence: 78%

Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective multicenter phase II trial

et al. 2014

View full text Add to dashboard Cite

ABSTRACTapproved by each institutional review board at the eight participating institutions, the Marseille II Ethical Committee, and the Cellular Therapy Committee of the French Agency for the Safety of Health Products. Written informed consent in accordance with the Declaration of Helsinki was obtained from eligible patients and their donors prior to inclusion in the study. This trial was registered with the European Union Drug Regulating Authorities Clinical Trials, n. 2005-005051-17. Patients aged 55 years or over presenting with a hematologic malignancy for which an allo-HSCT was indicated, as previously described, 8 were eligible if they had a matched related donor (MRD). The primary end point was the 1-year NRM cumulative incidence. Graft-versus-host disease (GvHD), relapse, progression-free survival (PFS), and overall survival (OS) were analyzed as secondary end points. Patients were enrolled in the study between

show abstract

supporting

confidence: 78%

Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective multicenter phase II trial

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In contrast, in a large registry trial of elderly patients, Alousi et al recently reported better survival after MRD≥50y-HSCT in comparison with MUD-HSCT, particularly for fit patients at the time of transplant. 39 Compared to our study, only 38% of MRD were older than 60 years in their study. By further exploring for a donor age cut off among MRD, they observed that patients who received grafts from MRD aged ≥67 years experienced higher relapse and mortality risks compared to those transplanted from younger MRD.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 41%

Pre-transplant prognostic factors of long-term survival after allogeneic peripheral blood stem cell transplantation with matched related/unrelated donors

et al. 2013

View full text Add to dashboard Cite

Mobilized peripheral blood has become the predominant stem cell source for allogeneic hematopoietic cell transplantation. In this retrospective single center study of 442 patients with hematologic malignancies, we analyzed prognostic factors for long-term survival after peripheral blood stem cell transplantation from HLA-matched related or unrelated donors. To account for disease/status heterogeneity, patients were risk-stratified according to the Disease Risk Index. Five-year overall survival was similar after transplants with matched related and unrelated donors (45% and 46%, respectively; P=0.49). Because donor age ≥60 years impacted outcome during model building, we further considered 3 groups of donors: matched unrelated (aged <60 years by definition), matched related aged <60 years and matched related aged ≥60 years. In multivariate analysis, the donor type/age group and the graft CD34+ and CD3 + cell doses impacted long-term survival. Compared with matched unrelated donor transplant, transplant from matched related donor <60 years resulted in similar long-term survival (P=0.67) while transplant from matched related donor ≥60 years was associated with higher risks for late mortality (hazard ratio (HR) 4.41; P=0.006) and treatment failure (HR: 6.33; P=0.009). Lower mortality risks were observed after transplant with CD34 + cell dose more than 4.5x10 6 /kg (HR: 0.56; P=0.002) and CD3 + cell dose more than 3x10 8 /kg (HR: 0.61; P=0.01). The Disease Risk Index failed to predict survival. We built an "adapted Disease Risk Index" by modifying risks for myeloproliferative neoplasms and multiple myeloma that improved stratification ability for progressionfree survival (P=0.04) but not for overall survival (P=0.82). Pre-transplant prognostic factors of long-term survival after allogeneic peripheral blood stem cell transplantation with matched related/unrelated donors ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o nHere, we report a large single center retrospective study of PB-HSCT with MRD or 10/10 MUD in patients with hematologic malignancies. To account for disease/status heterogeneity, patients were stratified for disease risk according to the DRI. The aims of this study were: 1) to evaluate how donor type (MRD vs. MUD) and other pretransplant factors may predict for long-term OS and PFS after PB-HSCT; and 2) to evaluate DRI as a predictor for OS and PFS. Methods PatientsWe performed a retrospective analysis of all consecutive patients with hematologic malignancies who underwent a first PB-HSCT from either MRD or MUD at Saint-Louis Hospital (Paris, France) between January 2000 and December 2010. According to institutional guidelines, MRD was considered as the first donor choice and search for MUD was only undertaken if no suitable MRD was identified. For MUD PB-HSCT, only donor/recipient pairs matched at the allelic level at HLA-A, -B, -C, -DRB1 and -DQB1 loci (10/10 HLA-matched) were included. Data concerning pre-transplant characteristics and transplant outcomes were extracted from our transplantatio...

show abstract

“…7 Similar results were published by another single-center study of 442 patients, which included various hematological malignancies but only PBSC as the source of stem cells. 8 Conversely, another study from the Center for International Bone and Marrow Transplant Research (CIBMTR) including more than 2000 patients older than 50 years with different hematological malignancies (patients with AML, n = 904) did not suggest such an advantage, 9 in line with the Fred Hutchinson Cancer Research Center experience published recently. 10 In daily practice, the use of unrelated donors implies less convenience, longer delay between CR1 to HCT and also less availability of donor lymphocyte infusions.…”

Section: Introductionmentioning

confidence: 77%

“…[7][8][9][10]17 Two studies did not find any difference between old MSD and MUD, 9,10 whereas the three others favored a MUD over a MSD. 7,8,17 It is important to note that the population being studied strongly influences the results.…”

Section: Discussionmentioning

confidence: 98%

“…One report addressed patients with AML only but in a small group of patients, 7 one study included patients who were transplanted only with PBSCs, 8 another one, patients with MDS only, 17 whereas the final two included various hematological malignancies. 9,10 One other important factor is the age limit of the selected populations. In general, if a patient is considered to be a candidate for HCT, a donor search is first performed among the siblings of the patient, who tend to have ages similar to the recipients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In patients older than 55 years with AML in first CR, should we search for a matched unrelated donor when an old sibling donor is available?

Latour

Labopin

Cornelissen

et al. 2015

Bone Marrow Transplant

View full text Add to dashboard Cite

on behalf of the Acute Leukemia Working Party of EBMT Allogeneic hematopoietic transplantation is increasingly used in patients aged 55 years or more with AML. The question of whether outcomes can be improved with an allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD, more than 55 years) is still unanswered. We thus analyzed outcomes in 714 patients aged 55 years and older with AML in first CR (CR1) who received PBSCs after a reduced-intensity conditioning hematopoietic cell transplant from a MUD (n = 310) or a MSD (n = 404) in a recent period (2005)(2006)(2007)(2008)(2009)(2010). The 3-year cumulative incidences (CIs) of non-relapse mortality were 17% and 23% with MSD and MUD, respectively (P = 0.17). The 3-year CIs of relapse were 37% and 30%, respectively (P = 0.12), resulting in a 3-year CI of leukemia-free survival of 46% and 47%, respectively (P = 0.51). The 3-year overall survival was 49% with both MSD and MUD.In conclusion, HLA-identical sibling donors aged 55 years or more should not be excluded because of age for patients aged 55 years and older with AML in CR1.

show abstract

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

Cited by 119 publications

References 23 publications

Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective multicenter phase II trial

Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective multicenter phase II trial

Pre-transplant prognostic factors of long-term survival after allogeneic peripheral blood stem cell transplantation with matched related/unrelated donors

In patients older than 55 years with AML in first CR, should we search for a matched unrelated donor when an old sibling donor is available?

Contact Info

Product

Resources

About