Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA.
Division of Hematology and Oncology, University of Washington, Seattle, WA.
Blood Adv. 2024 Oct 22;8(20):5306-5314. doi: 10.1182/bloodadvances.2024013853.
HLA-matched sibling donors (MSDs) are preferred for hematopoietic cell transplantation (HCT). However, the use of alternative donors, especially haploidentical, is increasing, as is our understanding of the impact of HLA factors such as B-leader and DRB1-matching on its outcomes. Yet, data comparing these donor types, particularly considering these HLA factors, is lacking. Herein, we compared haploidentical-HCT (n = 1052) with MSD-HCT (n = 400), both with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease prophylaxis. In multivariate analysis, haploidentical group had similar overall survival (OS; hazard ratio (HR), 0.94; 95% confidence interval [CI], 0.78-1.14; P = .54), nonrelapse mortality (HR, 0.98; 95% CI, 0.72-1.32; P = .87), and relapse (HR, 0.87; 95% CI, 0.70-1.08; P = .20) as the MSD group. Younger donor age was a significant predictor of improved OS. Next, we directly compared the outcomes of "younger" haploidentical (donor age <35 years, n = 347) vs an "older" MSD (donor age ≥50 years, n = 143) in older recipients (patient age ≥50 years). Patients with younger haploidentical B-leader-matched donors had significantly superior OS (HR, 0.65; 95% CI, 0.48-0.90; P = .009) than the older MSD group. Additionally, patients with younger DRB1-mismatched haploidentical donors (HR, 0.63; 95% CI, 0.46-0.87; P = .004) had significantly lower risk of relapse than older MSDs. Our study suggests that haploidentical-HCT may offer comparable outcomes to MSD-PTCy HCT. Moreover, among older patients, a younger haploidentical B-leader-matched donor might be preferable to an older MSD. These findings need validation in larger data sets.
HLA 匹配的同胞供者（MSD）是造血细胞移植（HCT）的首选。然而，替代供者的使用，尤其是单倍体相合供者，正在增加，我们对 HLA 因素（如 B 主导和 DRB1 匹配）对其结果的影响的理解也在增加。然而，缺乏比较这些供者类型的数据，特别是考虑到这些 HLA 因素。在此，我们比较了单倍体相合-HCT（n = 1052）与 MSD-HCT（n = 400），两者均采用移植后环磷酰胺（PTCy）为基础的移植物抗宿主病预防。多变量分析显示，单倍体相合组的总生存（OS；风险比（HR），0.94；95%置信区间[CI]，0.78-1.14；P =.54）、非复发死亡率（HR，0.98；95%CI，0.72-1.32；P =.87）和复发（HR，0.87；95%CI，0.70-1.08；P =.20）与 MSD 组相似。较年轻的供者年龄是 OS 改善的显著预测因素。接下来，我们直接比较了年龄较大的接受者（患者年龄≥50 岁）中较年轻的单倍体相合（供者年龄<35 岁，n = 347）与较老的 MSD（供者年龄≥50 岁，n = 143）的结果。具有较年轻的单倍体相合 B 主导匹配供者的患者具有显著优越的 OS（HR，0.65；95%CI，0.48-0.90；P =.009）比较老的 MSD 组。此外，具有较年轻的 DRB1 错配单倍体相合供者的患者（HR，0.63；95%CI，0.46-0.87；P =.004）的复发风险显著低于较老的 MSD。我们的研究表明，单倍体相合-HCT 可能提供与 MSD-PTCy HCT 相当的结果。此外，在年龄较大的患者中，年轻的单倍体相合 B 主导匹配供者可能优于年龄较大的 MSD。这些发现需要在更大的数据集上进行验证。
