Younger unrelated donors may be preferable over HLA match in the PTCy era: a study from the ALWP of the EBMT

July 10, 2024

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Publicated to:Blood. 143 (24): 2534-2543 - 2024-06-13 143(24), DOI: 10.1182/blood.2023023697

Authors: Sanz, Jaime; Labopin, Myriam; Choi, Goda; Kulagin, Alexander; Peccatori, Jacopo; Vydra, Jan; Remenyi, Peter; Versluis, Jurjen; Rovira, Montserrat; Blaise, Didier; Labussiere-Wallet, Helene; Montoro, Juan; Sica, Simona; Meijer, Ellen; Itala-Remes, Maija; Schaap, Nicolaas; Bulabois, Claude Eric; Piemontese, Simona; Mohty, Mohamad; Ciceri, Fabio

Affiliations

Ctr Hosp Lyon Sud, Lyon, France - Author

Del Pesti Centrumkorhaz, Budapest, Hungary - Author

Erasmus MC Canc Inst, Rotterdam, Netherlands - Author

Hosp St Antoine, EBMT Paris Off, Paris, France - Author

Hosp Univ & Politecn La Fe, Hematol Dept, Valencia, Spain - Author

Inst Carlos III, CIBERONC, Madrid, Spain - Author

Inst Hematol & Blood Transfus Prague, Prague, Czech Republic - Author

Pavlov Univ, Raisa Gorbacheva Mem Res Inst, St Petersburg, Russia - Author

Programme Transplantat & Therapie Cellulaire Marse, Marseille, France - Author

Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands - Author

San Raffaele Sci Inst IRCCS, Hematol & Bone Marrow Transplant Unit, Milan, Italy - Author

Sorbonne Univ, Hop St Antoine, INSERM UMRs 938, Paris, France - Author

Turku Univ Hosp, Turku, Finland - Author

Univ Barcelona, Hosp Clin, BMT Unit, Dept Haematol,IDIBAPS,Inst Haematol & Oncol,Josep, Barcelona, Spain - Author

Univ Cattolica Sacro Cuore, Rome, Italy - Author

Univ Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France - Author

Univ Med Ctr Groningen, Groningen, Netherlands - Author

Univ Vita Salute San Raffaele, Milan, Italy - Author

Vrije Univ Amsterdam, Med Ctr, Amsterdam, Netherlands - Author

Abstract

There is a paucity of information on how to select the most appropriate unrelated donor (UD) in hematopoietic stem cell transplantation (HSCT) using posttransplant cyclophosphamide (PTCy). We retrospectively analyzed the characteristics of 10/10 matched UDs (MUDs) and 9/10 mismatched UDs (MMUDs) that may affect transplant outcomes in patients with acute myeloid leukemia (AML) in fi rst or second complete remission (CR1 or CR2). The primary end point was leukemia-free survival (LFS). Overall, 1011 patients were included with a median age of 54 years (range, 18-77). Donors had a median age of 29 years (range, 18-64); 304 (30%) were females, of which 150 (15% of the whole group) were donors to male recipients, and 621 (61%) were MUDs; 522 (52%) had negative cytomegalovirus (CMV -neg) serostatus, of which 189 (19%) were used for CMV -neg recipients. Donor age older than 30 years had a negative impact on relapse (hazard ratio [HR], 1.38; 95% con fi dence interval [CI], 1.06-1.8), LFS (HR, 1.4; 95% CI, 1.12-1.74), overall survival (HR 1.45; 95% CI, 1.14-1.85) and graft-versus-host disease (GVHD) free, relapse-free survival (HR, 1.29; 95% CI, 1.07-1.56). In addition, CMV -neg donors for CMV -neg recipients were associated with improved LFS (HR, 0.74; 95% CI, 0.55-0.99). The use of MMUD and female donors for male recipients did not signi fi cantly impact any transplant outcomes. For patients undergoing HSCT from a UD with PTCy for AML, donor age

Keywords

Acute myeloid leukemiaAdolescentAdultAgeAge factorsAgedAlemtuzumabAlleleArticleBone-marrowCalcineurin inhibitorCancer specific survivalCumulative incidenceCyclophosphamideCytogeneticsCytomegalovirusDisease free survivalDisease-free survivalEtiologyFemaleGraft versus host reactionGraft vs host diseaseGrowth hormone releasing factorHematopoietic stem cell transplantationHistocompatibility testHistocompatibility testingHla antigenHla antigensHla systemHumanHumansImmunologyImpactKarnofsky performance statusLeukemiLeukemia, myeloid, acuteMajor clinical studyMaleMiddle agedMismatchMortalityMycophenolate mofetilOverall survivalPosttransplant cyclophosphamideRecipientsRecurrence free survivalRemissionRetrospective studiesRetrospective studyRisk factorSirolimusStem-cell transplantationSurvivalT cell depletionTherapyThymocyte antibodyTransplantationTreatment outcomeUnrelated donorUnrelated donorsYoung adult

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The work has been published in the journal Blood due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 2/98, thus managing to position itself as a Q1 (Primer Cuartil), in the category Hematology. Notably, the journal is positioned above the 90th percentile.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-07-26:

WoS: 17
Scopus: 9

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This work has been carried out with international collaboration, specifically with researchers from: Czech Republic; Finland; France; Hungary; Italy; Netherlands; Russia.

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