1. Impact of donor age and kinship on clinical outcomes after T-cell–replete haploidentical transplantation with PT-Cy
- Author
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Samia Harbi, Alessandra Sperotto, Luca Castagna, Massimo Martino, Antonio M. Risitano, Luisa Giaccone, Andrea Bacigalupo, Lucia Savino, Alessandro Busca, Andrea Evangelista, Camilla Frieri, Sabine Furst, Luana Marano, Serena Marotta, Armando Santoro, Barbara Loteta, Emanuela Merla, Francesca Patriarca, Benedetto Bruno, Lucia Brunello, Didier Blaise, Patrizia Chiusolo, Anna Maria Raiola, Giuseppe Console, Domenico Mavilio, Stefania Bramanti, Jacopo Mariotti, Simona Sica, Angelo Michele Carella, Emanuele Angelucci, Renato Fanin, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Cyclophosphamide ,T-Lymphocytes ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,Cumulative incidence ,ComputingMilieux_MISCELLANEOUS ,Aged ,Retrospective Studies ,impact of donor age and kinship on clinical outcomes after T cell-replete haploidentical transplantation with PT-Cv ,business.industry ,Donor selection ,Incidence (epidemiology) ,Hazard ratio ,Hematopoietic Stem Cell Transplantation ,Retrospective cohort study ,Hematology ,3. Good health ,Transplantation ,Settore MED/15 - MALATTIE DEL SANGUE ,030220 oncology & carcinogenesis ,Transplantation, Haploidentical ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Female ,Stem cell ,Neoplasm Recurrence, Local ,Erratum ,business ,030215 immunology ,medicine.drug - Abstract
Donor selection contributes to improve clinical outcomes of T-cell–replete haploidentical stem cell transplantation (haplo-SCT) with posttransplant cyclophosphamide (PT-Cy). The impact of donor age and other non-HLA donor characteristics remains a matter of debate. We performed a multicenter retrospective analysis on 990 haplo-SCTs with PT-Cy. By multivariable analysis, after adjusting for donor/recipient kinship, increasing donor age and peripheral blood stem cell graft were associated with a higher risk of grade 2 to 4 acute graft-versus-host-disease (aGVHD), whereas 2-year cumulative incidence of moderate-to-severe chronic GVHD was higher for transplants from female donors into male recipients and after myeloablative conditioning. Increasing donor age was associated with a trend for higher nonrelapse mortality (NRM) (hazard ratio [HR], 1.05; P = .057) but with a significant reduced risk of disease relapse (HR, 0.92; P = .001) and improved progression-free survival (PFS) (HR, 0.97; P = .036). Increasing recipient age was a predictor of worse overall survival (OS). Risk of relapse was higher (HR, 1.39; P < .001) in patients aged ≤40 years receiving a transplant from a parent as compared with a sibling. Moreover, OS and PFS were lower when the donor was the mother rather than the father. Pretransplant active disease status was an invariably independent predictor of worse clinical outcomes, while recipient positive cytomegalovirus serostatus and hematopoietic cell transplant comorbidity index >3 were associated with worse OS and PFS. Our results suggest that younger donors may reduce the incidence of aGVHD and NRM, though at higher risk of relapse. A parent donor, particularly the mother, is not recommended in recipients ≤40 years.
- Published
- 2020