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2024-09-11T13:57:12.000Z

Impact of donor age and type in patients with AML undergoing allo-HSCT

Sep 11, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in AML.

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

Key learnings

Results suggest that allo-HSCT from young haplo donors (median age, 27.8 years) is associated with a lower incidence of Grade IIIV 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). 

Compared with older haplo donors (median age), patients transplanted with younger MMUD (median age) had a reduced risk of Grade IIIV 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.  

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. 

  1. 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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