Hans Messner Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden.
Transplant Cell Ther. 2023 Nov;29(11):697.e1-697.e10. doi: 10.1016/j.jtct.2023.08.009. Epub 2023 Aug 12.
The choice between an older matched sibling donor (MSD) and a younger matched unrelated donor (MUD) in allogeneic hematopoietic cell transplantation (HCT) remains a subject of ongoing debate. In this single-center retrospective study of 377 patients who received peripheral blood stem cell (PBSC) transplants for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS), we compared outcomes of 85 patients who received grafts from MSDs age >60 years and 292 patients who received grafts from MUDs age <30 years. Compared to recipients of MSD transplants, recipients of MUD transplants were younger and more likely to receive dual T cell depletion (TCD), a higher CD34 cell dose, and a fresh graft. Recipients of MSD transplants were maintained on immunosuppressive therapy longer than those who received MUD grafts. We found no differences in overall survival, relapse-free survival, graft-versus-host disease (GVHD)-free and relapse-free survival, nonrelapse mortality, relapse, engraftment, graft failure, and acute GVHD between recipients of MSD grafts and recipients of MUD grafts. We report a higher 30-day incidence, but not 1-year incidence, of bloodstream infections among recipients of MUD transplants compared to subjects who received their grafts from a MSD. The incidence of moderate-severe chronic GVHD was higher in MSD graft recipients compared with MUD graft recipients in univariate analysis, but not in multivariate analysis. Although this difference could reflect the greater use of dual TCD, known to be associated with very low rates of chronic GVHD in MUD transplant recipients, the incidence of moderate-severe chronic GVHD was no different between MSD and MUD transplant recipients following propensity score matching, suggesting that other variables could be responsible. Taken together, our data suggest that in patients with AML or MDS who receive PBSC transplants, such factors as convenience, ease of access, and costs should be considered when selecting an older MSD over a younger MUD.
在异基因造血细胞移植（HCT）中，选择年龄较大的匹配同胞供者（MSD）与年龄较小的匹配无关供者（MUD）仍然是一个持续存在的争议问题。在这项对 377 例接受外周血造血干细胞（PBSC）移植治疗急性髓细胞白血病（AML）或骨髓增生异常综合征（MDS）的患者的单中心回顾性研究中，我们比较了 85 例接受 MSD ＞60 岁供者移植物和 292 例接受 MUD ＜30 岁供者移植物患者的结局。与接受 MSD 移植的受者相比，接受 MUD 移植的受者年龄较小，更可能接受双重 T 细胞耗竭（TCD），CD34 细胞剂量较高，且为新鲜移植物。接受 MSD 移植的受者接受免疫抑制治疗的时间长于接受 MUD 移植物的受者。我们发现，接受 MSD 移植的患者与接受 MUD 移植的患者在总生存率、无复发生存率、无移植物抗宿主病（GVHD）-无复发生存率、非复发死亡率、复发、植入、移植物失败和急性 GVHD 方面没有差异。与接受 MSD 供者移植物的患者相比，接受 MUD 供者移植物的患者 30 天感染血液感染的发生率较高，但 1 年感染血液感染的发生率没有差异。在单变量分析中，MSD 移植物受者的中重度慢性 GVHD 发生率高于 MUD 移植物受者，但在多变量分析中没有差异。虽然这种差异可能反映了双重 TCD 的应用更多，已知在 MUD 移植受者中与慢性 GVHD 的发生率非常低有关，但在倾向评分匹配后，MSD 和 MUD 移植受者的中重度慢性 GVHD 发生率没有差异，这表明其他变量可能是导致差异的原因。综上所述，我们的数据表明，在接受 PBSC 移植的 AML 或 MDS 患者中，在选择年龄较大的 MSD 而不是年轻的 MUD 时，应考虑便利性、可及性和成本等因素。
