TY - JOUR
T1 - Who is the better donor for older hematopoietic transplant recipients
T2 - An older-aged sibling or a young, matched unrelated volunteer?
AU - Alousi, Amin M.
AU - Le-Rademacher, Jennifer
AU - Saliba, Rima M.
AU - Appelbaum, Frederick R.
AU - Artz, Andrew
AU - Benjamin, Jonathan
AU - Devine, Steven M.
AU - Kan, Fangyu
AU - Laughlin, Mary J.
AU - Lazarus, Hillard M.
AU - Liesveld, Jane
AU - Perales, Miguel Angel
AU - Maziarz, Richard T.
AU - Sabloff, Mitchell
AU - Waller, Edmund K.
AU - Eapen, Mary
AU - Champlin, Richard E.
N1 - Funding Information:
This work was supported by a Public Health Service grant (U24-CA76518) from the National Cancer Institute, the National Heart, Lung and Blood Institute, and the National Institute of Allergy and Infectious Diseases; a grant (HHSH234200637015C) from the Health Resources and Services Administration; and a grant (N00014-10-01-0204) from the Office of Naval Research, Department of Navy to the National Marrow Donor Program. Opinions, findings, and conclusions or recommendations expressed herein are those of the authors and do not reflect the views of the Office of Naval Research or the National Marrow Donor Program.
Publisher Copyright:
© 2013 by The American Society of Hematology.
PY - 2013
Y1 - 2013
N2 - Older patients are increasingly undergoing allogeneic hematopoietic transplantation. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/lymphoma patients age ‡50 years were analyzed comparing outcomes for recipients of MSD ‡50 (n 5 1415) versus MUD <50 years (n 5 757). Risks of acute graft-versus-host disease (GVHD) grade 2 to 4 (hazard ratio [HR], 1.63; P < .001), 3 to 4 (HR, 1.85; P < .001), and chronic GVHD (HR, 1.48; P < .0001) were higher after MUD compared with MSD transplants. The effect of donor type on nonrelapse mortality (NRM), relapse, and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR, 1.42; P 5 .001), relapse (HR, 1.45; P < .001), and overall mortality (HR, 1.28; P 5 .001) risks were higher after MUD transplants. For patients with scores below 90, NRM (HR, 0.96; P 5 .76), relapse (HR, 0.86; P 5 .25), and overall mortality (HR, 0.90; P 5 .29) were not significantly different after MUD and MSD transplants. These data favor an MSD over a MUD in patients age ‡50 years.
AB - Older patients are increasingly undergoing allogeneic hematopoietic transplantation. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/lymphoma patients age ‡50 years were analyzed comparing outcomes for recipients of MSD ‡50 (n 5 1415) versus MUD <50 years (n 5 757). Risks of acute graft-versus-host disease (GVHD) grade 2 to 4 (hazard ratio [HR], 1.63; P < .001), 3 to 4 (HR, 1.85; P < .001), and chronic GVHD (HR, 1.48; P < .0001) were higher after MUD compared with MSD transplants. The effect of donor type on nonrelapse mortality (NRM), relapse, and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR, 1.42; P 5 .001), relapse (HR, 1.45; P < .001), and overall mortality (HR, 1.28; P 5 .001) risks were higher after MUD transplants. For patients with scores below 90, NRM (HR, 0.96; P 5 .76), relapse (HR, 0.86; P 5 .25), and overall mortality (HR, 0.90; P 5 .29) were not significantly different after MUD and MSD transplants. These data favor an MSD over a MUD in patients age ‡50 years.
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U2 - 10.1182/blood-2012-08-453860
DO - 10.1182/blood-2012-08-453860
M3 - Article
C2 - 23361908
AN - SCOPUS:84878406500
SN - 0006-4971
VL - 121
SP - 2567
EP - 2573
JO - Blood
JF - Blood
IS - 13
ER -