与年长的同胞相比，年轻的非亲属供者为髓系恶性肿瘤患者带来生存优势。
Young unrelated donors confer a survival advantage for patients with myeloid malignancies compared to older siblings.
作者信息
Schetelig Johannes, Baldauf Henning, Rave Carina, Bug Gesine, Müller Lutz P, Wagner-Drouet Eva Maria, Ayuk Francis Ayuketang, Bethge Wolfgang, Stelljes Matthias, Schroeder Thomas, Stölzel Friedrich, Jost Edgar, Schmid Christoph, Kunadt Desiree, Sockel Katja, Egger-Heidrich Katharina, Middeke Jan Moritz, Fürst Daniel, Schefzyk Daniel, Sauter Jürgen, Schmidt Alexander H, Fleischhauer Katharina, Bornhäuser Martin
机构信息
Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
DKMS Clinical Trials Unit, DKMS Group, Dresden, Germany.
出版信息
Leukemia. 2025 Aug 6. doi: 10.1038/s41375-025-02724-1.
Donor age is one factor to optimize allogeneic hematopoietic cell transplantation (alloHCT). Therefore, we investigated whether young unrelated donors (UD) provide a benefit for older patients with myeloid malignancies compared to HLA-identical sibling donors (MSD). We performed a retrospective registry study on patients ≥50 years who received a first alloHCT between 2010 and 2020. We compared event-free survival (EFS) of patients who were transplanted from MSD aged ≥50 years versus UD aged ≤35 years who were HLA-compatible for HLA-A, -B, -C, and -DRB1. In total, we analyzed data from 3460 patients. With multivariable adjustment EFS (HR 0.86, p = 0.003), OS (HR 0.82, p < 0.001), and risk of relapse (HR 0.84, p = 0.018) were significantly better for HLA-compatible UD compared to MSD. No survival advantage was found, when UD with unfavorable sex or CMV constellation were compared to MSD with favorable constellations. In a meta-analysis on 9905 patients with myeloid malignancies, including ours, we found reduced risk of relapse (pooled HR 0.78, p = 0.006) and better EFS (pooled HR 0.89, p < 0.001) for young matched UD versus MSD. To select young HLA-compatible UD over older MSD may reduce relapse risk and improve survival for older patients with myeloid malignancies.
供者年龄是优化异基因造血细胞移植（alloHCT）的一个因素。因此，我们研究了年轻的非血缘供者（UD）与HLA全相合的同胞供者（MSD）相比，是否能为老年髓系恶性肿瘤患者带来益处。我们对2010年至2020年间接受首次alloHCT的≥50岁患者进行了一项回顾性登记研究。我们比较了接受年龄≥50岁的MSD移植的患者与年龄≤35岁且HLA-A、-B、-C和-DRB1 HLA相合的UD移植的患者的无事件生存期（EFS）。我们总共分析了3460例患者的数据。经过多变量调整后，与MSD相比，HLA相合的UD的EFS（风险比[HR] 0.86，p = 0.003）、总生存期（OS，HR 0.82，p < 0.001）和复发风险（HR 0.84，p = 0.018）均显著更好。当将具有不利性别或巨细胞病毒（CMV）情况的UD与具有有利情况的MSD进行比较时，未发现生存优势。在一项对包括我们研究在内的9905例髓系恶性肿瘤患者的荟萃分析中，我们发现年轻的匹配UD与MSD相比，复发风险降低（合并HR 0.78，p = 0.006）且EFS更好（合并HR 0.89，p < 0.001）。选择年轻的HLA相合的UD而非年长的MSD可能会降低老年髓系恶性肿瘤患者的复发风险并改善生存。
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