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Impact of donor age and type in patients with AML undergoing allo-HSCT
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A retrospective analysis compared transplant outcomes in patients with acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), with post-transplant cyclophosphamide (PTCy), from young (<30 years) haploidentical (haplo) donors vs old (≥35 years) mismatched unrelated donors (MMUD), and old haplo donors vs young MMUD.1 The analysis included 2,798 patients (young haplo, n = 1065; old MMUD, n = 147; old haplo, n = 1315; young MMUD, n = 271) from a dataset of the Acute Leukemia Working (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT). Results were published in Bone Marrow Transplantation by Nagler et al.1
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Results suggest that allo-HSCT from young haplo donors (median age, 27.8 years) is associated with a lower incidence of Grade II–IV acute graft-versus-host disease (aGvHD) at Day 180 compared with old MMUD (median age, 41.8 years; 22.6% vs 35.7%; hazard ratio [HR], 0.62; p = 0.007), without differences in other key outcomes, such as chronic GvHD, relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS), overall survival (OS), and GvHD-free and relapse-free survival (GRFS). |
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Compared with older haplo donors (median age), patients transplanted with younger MMUD (median age) had a reduced risk of Grade II–IV aGvHD at Day 180 (24.3% vs 31%; HR, 0.69; p = 0.013) and a lower 2-year NRM rate (11.6% vs 22.4%; HR, 0.60; p = 0.022). RI, LFS, OS, and GRFS were similar between groups. |
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The study highlights that donor age is a critical factor impacting transplant outcomes, and suggests that younger, alternative donors should be prioritized when selecting donors for allo-HSCT with PTCy in patients with AML. These findings also warrant further investigation in prospective age-focused studies. |
- Nagler A, Labopin M, Swoboda R, et al. Young (<35 years) haploidentical versus old (≥35 years) mismatched unrelated donors and vice versa for allogeneic stem cell transplantation with post-transplant cyclophosphamide in patients with acute myeloid leukemia in first remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant. 2024. Online ahead of print. DOI: 10.1038/s41409-024-02400-5
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