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在HLA不匹配的无关供体和单倍型相合供体之间进行选择:供体年龄的考量

Choosing Between HLA-Mismatched Unrelated and Haploidentical Donors: Donor Age Considerations.

作者信息

Mehta Rohtesh S, Schmidt Gabrielle, Williams Kirsten, Patel Shyam A, Schetelig Johannes, Savani Bipin, Askar Medhat, Petersdorf Effie, Ringden Olle, Kanakry Christopher G, Kanakry Jennifer A, Stefanski Heather, Arrieta-Bolaños Esteban, Betts Brian, Benjamin Cara, Gadalla Shahinaz, Wang Tao, Saultz Jennifer, Spellman Stephen, Jurdi Najla El, Bolon Yung-Tsi, Lee Stephanie J

机构信息

Stem Cell Transplantation and Cellular Therapies, University of Texas, MD Anderson Cancer Center, Houston, Texas.

CIBMTR® (Center for International Blood and Marrow Transplant Research), NMDP, Minneapolis, Minnesota.

出版信息

Transplant Cell Ther. 2025 Sep;31(9):680-692. doi: 10.1016/j.jtct.2025.05.019. Epub 2025 May 24.

Abstract

Haploidentical donors and HLA-mismatched unrelated donors (MMUDs) are increasingly utilized for hematopoietic cell transplantation (HCT), with post-transplantation cyclophosphamide (PTCy) emerging as an effective graft-versus-host disease (GVHD) prophylaxis strategy. Despite the growing use of these donor types, comparative data to guide donor selection remain limited. Donor age is a known predictor of HCT outcomes, yet its specific impact when choosing between haploidentical and MMUD donors with PTCy-based prophylaxis has not been thoroughly explored. This study aimed to evaluate the influence of donor age on HCT outcomes in patients receiving haploidentical or MMUD HCT with PTCy-based GVHD prophylaxis, hypothesizing that younger donors (<30 years) would be associated with improved outcomes compared to older donors (≥30 years) regardless of donor type. We conducted a retrospective analysis of 7116 patients with hematologic malignancies from the Center for International Blood and Marrow Transplant Research database, transplanted between 2013 and 2021. Donors were categorized into four groups: younger haploidentical (<30 years), older haploidentical (≥30 years), younger MMUD (<30 years), and older MMUD (≥30 years). The primary outcome was GVHD-free relapse-free survival (GRFS), defined as the absence of grade III to IV acute GVHD, chronic GVHD requiring systemic immunosuppressive therapy (IST), relapse, or death. Secondary outcomes included overall survival, treatment-related mortality (TRM), relapse, grade III to IV acute GVHD, overall chronic GVHD, and chronic GVHD requiring IST. Comparisons were made between (1) younger MMUD versus older haploidentical and (2) younger haploidentical versus older MMUD groups using multivariable Cox proportional hazards models. In multivariable analysis, the older MMUD group exhibited inferior GRFS (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.06 to 1.36; P = .003), higher TRM (HR 1.49; 95% CI, 1.13 to 1.96; P = .005), and increased grade III to IV acute GVHD (HR 2.88; 95% CI, 1.43 to 5.80; P = .003) compared to the younger haploidentical group. The younger MMUD group had modest GRFS improvement over the older haploidentical group (HR 0.87; 95% CI, 0.78 to 0.98; P = .02) and significantly reduced risks of grade II to IV acute GVHD (HR 0.67; 95% CI, 0.51 to 0.88; P = .003) and chronic GVHD (HR 0.78; 95% CI, 0.65 to 0.94; P = .009). Younger donor age is associated with superior HCT outcomes, emphasizing the importance of prioritizing donors aged <30 years regardless of donor type when feasible.

摘要

单倍体相合供者和人类白细胞抗原(HLA)配型不合的非血缘供者(MMUDs)越来越多地用于造血细胞移植(HCT),移植后环磷酰胺(PTCy)已成为一种有效的移植物抗宿主病(GVHD)预防策略。尽管这些供者类型的使用越来越多,但指导供者选择的比较数据仍然有限。供者年龄是已知的HCT结果预测因素,然而,在基于PTCy预防的单倍体相合供者和MMUD供者之间进行选择时,其具体影响尚未得到充分探讨。本研究旨在评估供者年龄对接受基于PTCy的GVHD预防的单倍体相合或MMUD HCT患者的HCT结果的影响,假设年轻供者(<30岁)与年长供者(≥30岁)相比,无论供者类型如何,其结果都会更好。我们对国际血液和骨髓移植研究中心数据库中2013年至2021年间接受移植的7116例血液系统恶性肿瘤患者进行了回顾性分析。供者分为四组:年轻单倍体相合供者(<30岁)、年长单倍体相合供者(≥30岁)、年轻MMUD供者(<30岁)和年长MMUD供者(≥30岁)。主要结局是无GVHD无复发生存期(GRFS)定义为无III至IV级急性GVHD、需要全身免疫抑制治疗(IST)的慢性GVHD、复发或死亡。次要结局包括总生存期、治疗相关死亡率(TRM)、复发、III至IV级急性GVHD、总体慢性GVHD以及需要IST的慢性GVHD。使用多变量Cox比例风险模型对(1)年轻MMUD供者与年长单倍体相合供者和(2)年轻单倍体相合供者与年长MMUD供者组进行比较。在多变量分析中,与年轻单倍体相合供者组相比,年长MMUD供者组的GRFS较差(风险比[HR]1.20;95%置信区间[CI],1.06至1.36;P = 0.003),TRM较高(HR 1.49;95%CI,1.13至1.96;P = 0.005),III至IV级急性GVHD增加(HR 2.88;95%CI,1.43至5.80;P = 0.003)。年轻MMUD供者组的GRFS比年长单倍体相合供者组有适度改善(HR 0.87;95%CI),0.78至0.98;P = 0.02),II至IV级急性GVHD和慢性GVHD的风险显著降低(HR 0.67;95%CI,0.51至0.88;P = 0.003)和慢性GVHD(HR为0.78;95%CI,0.65至0.94;P = 0.009)。供者年龄越年轻,HCT结果越好,这强调了在可行的情况下,无论供者类型如何,优先选择年龄<30岁的供者的重要性。

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Novel machine learning technique further clarifies unrelated donor selection to optimize transplantation outcomes.
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3
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Blood Adv. 2024 May 14;8(9):2235-2242. doi: 10.1182/bloodadvances.2024012669.
8
Haploidentical stem cell donor choice for patients with acute myeloid leukemia: a study from the ALWP of the EBMT.
Blood Adv. 2024 May 28;8(10):2332-2341. doi: 10.1182/bloodadvances.2023012133.
10
Age-related thymic involution: Mechanisms and functional impact.
Aging Cell. 2022 Aug;21(8):e13671. doi: 10.1111/acel.13671. Epub 2022 Jul 12.

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