TY - JOUR
T1 - Impact of the combination of donor age and HLA disparity on the outcomes of unrelated bone marrow transplantation
AU - for the JSHCT Donor Source Working Group
AU - Seo, Sachiko
AU - Usui, Yoshiaki
AU - Matsuo, Keitaro
AU - Atsuta, Yoshiko
AU - Igarashi, Aiko
AU - Fukuda, Takahiro
AU - Ozawa, Yukiyasu
AU - Katayama, Yuta
AU - Yoshida, Shuro
AU - Uchida, Naoyuki
AU - Kondo, Tadakazu
AU - Kako, Shinichi
AU - Tsukada, Nobuhiro
AU - Kato, Shunichi
AU - Onizuka, Makoto
AU - Ichinohe, Tatsuo
AU - Kimura, Fumihiko
AU - Kanda, Yoshinobu
AU - Miyamura, Koichi
AU - Kanda, Junya
AU - Ago, Hiroatsu
AU - Imai, Kiyotoshi
AU - Uchida, Naoyuki
AU - Kato, Koji
AU - Kato, Shuichi
AU - Kuwatsuka, Yachiyo
AU - Kobayashi, Takeshi
AU - Sawa, Masashi
AU - Sunami, Kazutaka
AU - Seo, Sachiko
AU - Tanaka, Masatsugu
AU - Taniguchi, Shuichi
AU - Tabuchi, Ken
AU - Tsukada, Nobuhiro
AU - Terakura, Seitaro
AU - Nagata, Yasuyuki
AU - Nishiwaki, Satoshi
AU - Fujita, Naoto
AU - Matsuno, Ryosuke
AU - Matsumoto, Kimikazu
AU - Mitamura, Shin
AU - Miyamura, Koichi
AU - Morishima, Yasuo
AU - Yakushijin, Kimikazu
AU - Watanabe, Syudai
AU - Ishiyama, Ken
AU - Kimura, Fumihiko
AU - Nagafuji, Koji
AU - Yabe, Toshio
AU - Kawamura, Koji
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Impact of donor age considering HLA disparity on hematopoietic cell transplantation (HCT) outcomes has not been fully evaluated. We evaluated 8486 patients who received unrelated bone marrow transplantation (UR-BMT) from 8/8 or 7/8 HLA-matched donors. Compared to 8/8 HLA-matched younger donors (<40 years), 8/8 HLA-matched older donors (subdistribution hazard ratio [SHR], 1.16; 95% CI, 0.97–1.38) and 7/8 HLA-matched younger donors (SHR, 1.33; 95% CI, 1.11–1.58) were associated with increased risk of grade III–IV acute graft-versus-host disease (aGVHD). 7/8 HLA-matched older donors had further increased risk (SHR, 2.00; 95% CI, 1.68–2.38) due to interaction between donor age and HLA disparity (p for interaction = 0.038). Progression-free survival (PFS) after UR-BMT with 8/8 HLA-matched younger donors was comparable to that after UR-BMT with 8/8 HLA-matched older donors, whereas UR-BMT with 7/8 HLA-matched younger or older donors was significantly associated with lower PFS than UR-BMT with 8/8 HLA-matched younger donors (younger donor; HR, 1.12; 95% CI, 1.04–1.21, older donor; HR, 1.28; 95% CI, 1.17–1.40; p for interaction = 0.079). In conclusion, adverse effect of increased donor age requires attention, especially in HLA-mismatched UR-BMT due to interaction between donor age and HLA disparity. Intensive aGVHD prophylaxis may be required to improve outcomes after HCT with mismatched older donors.
AB - Impact of donor age considering HLA disparity on hematopoietic cell transplantation (HCT) outcomes has not been fully evaluated. We evaluated 8486 patients who received unrelated bone marrow transplantation (UR-BMT) from 8/8 or 7/8 HLA-matched donors. Compared to 8/8 HLA-matched younger donors (<40 years), 8/8 HLA-matched older donors (subdistribution hazard ratio [SHR], 1.16; 95% CI, 0.97–1.38) and 7/8 HLA-matched younger donors (SHR, 1.33; 95% CI, 1.11–1.58) were associated with increased risk of grade III–IV acute graft-versus-host disease (aGVHD). 7/8 HLA-matched older donors had further increased risk (SHR, 2.00; 95% CI, 1.68–2.38) due to interaction between donor age and HLA disparity (p for interaction = 0.038). Progression-free survival (PFS) after UR-BMT with 8/8 HLA-matched younger donors was comparable to that after UR-BMT with 8/8 HLA-matched older donors, whereas UR-BMT with 7/8 HLA-matched younger or older donors was significantly associated with lower PFS than UR-BMT with 8/8 HLA-matched younger donors (younger donor; HR, 1.12; 95% CI, 1.04–1.21, older donor; HR, 1.28; 95% CI, 1.17–1.40; p for interaction = 0.079). In conclusion, adverse effect of increased donor age requires attention, especially in HLA-mismatched UR-BMT due to interaction between donor age and HLA disparity. Intensive aGVHD prophylaxis may be required to improve outcomes after HCT with mismatched older donors.
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U2 - 10.1038/s41409-021-01289-8
DO - 10.1038/s41409-021-01289-8
M3 - Article
C2 - 33990702
AN - SCOPUS:85105956461
SN - 0268-3369
VL - 56
SP - 2410
EP - 2422
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 10
ER -