Who is the better donor for older hematopoietic transplant recipients

An older-aged sibling or a young, matched unrelated volunteer?

Amin M. Alousi, Jennifer Le-Rademacher, Rima M. Saliba, Frederick R. Appelbaum, Andrew Artz, Jonathan Benjamin, Steven M. Devine, Fangyu Kan, Mary J. Laughlin, Hillard M. Lazarus, Jane Liesveld, Miguel Angel Perales, Richard T. Maziarz, Mitchell Sabloff, Edmund K. Waller, Mary Eapen, Richard E. Champlin

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Older patients are increasingly undergoing allogeneic hematopoietic transplantation. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/lymphoma patients age ‡50 years were analyzed comparing outcomes for recipients of MSD ‡50 (n 5 1415) versus MUD <50 years (n 5 757). Risks of acute graft-versus-host disease (GVHD) grade 2 to 4 (hazard ratio [HR], 1.63; P < .001), 3 to 4 (HR, 1.85; P < .001), and chronic GVHD (HR, 1.48; P < .0001) were higher after MUD compared with MSD transplants. The effect of donor type on nonrelapse mortality (NRM), relapse, and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR, 1.42; P 5 .001), relapse (HR, 1.45; P < .001), and overall mortality (HR, 1.28; P 5 .001) risks were higher after MUD transplants. For patients with scores below 90, NRM (HR, 0.96; P 5 .76), relapse (HR, 0.86; P 5 .25), and overall mortality (HR, 0.90; P 5 .29) were not significantly different after MUD and MSD transplants. These data favor an MSD over a MUD in patients age ‡50 years.

Original languageEnglish (US)
Pages (from-to)2567-2573
Number of pages7
JournalBlood
Volume121
Issue number13
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Unrelated Donors
Transplants
Siblings
Volunteers
Hazards
Tissue Donors
Mortality
Graft vs Host Disease
Recurrence
Grafts
Homologous Transplantation
Transplant Recipients
Lymphoma
Leukemia
Alleles

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Who is the better donor for older hematopoietic transplant recipients : An older-aged sibling or a young, matched unrelated volunteer? / Alousi, Amin M.; Le-Rademacher, Jennifer; Saliba, Rima M.; Appelbaum, Frederick R.; Artz, Andrew; Benjamin, Jonathan; Devine, Steven M.; Kan, Fangyu; Laughlin, Mary J.; Lazarus, Hillard M.; Liesveld, Jane; Perales, Miguel Angel; Maziarz, Richard T.; Sabloff, Mitchell; Waller, Edmund K.; Eapen, Mary; Champlin, Richard E.

In: Blood, Vol. 121, No. 13, 01.01.2013, p. 2567-2573.

Research output: Contribution to journalArticle

Alousi, AM, Le-Rademacher, J, Saliba, RM, Appelbaum, FR, Artz, A, Benjamin, J, Devine, SM, Kan, F, Laughlin, MJ, Lazarus, HM, Liesveld, J, Perales, MA, Maziarz, RT, Sabloff, M, Waller, EK, Eapen, M & Champlin, RE 2013, 'Who is the better donor for older hematopoietic transplant recipients: An older-aged sibling or a young, matched unrelated volunteer?', Blood, vol. 121, no. 13, pp. 2567-2573. https://doi.org/10.1182/blood-2012-08-453860
Alousi, Amin M. ; Le-Rademacher, Jennifer ; Saliba, Rima M. ; Appelbaum, Frederick R. ; Artz, Andrew ; Benjamin, Jonathan ; Devine, Steven M. ; Kan, Fangyu ; Laughlin, Mary J. ; Lazarus, Hillard M. ; Liesveld, Jane ; Perales, Miguel Angel ; Maziarz, Richard T. ; Sabloff, Mitchell ; Waller, Edmund K. ; Eapen, Mary ; Champlin, Richard E. / Who is the better donor for older hematopoietic transplant recipients : An older-aged sibling or a young, matched unrelated volunteer?. In: Blood. 2013 ; Vol. 121, No. 13. pp. 2567-2573.
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abstract = "Older patients are increasingly undergoing allogeneic hematopoietic transplantation. A relevant question is whether outcomes can be improved with a younger allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD). Accordingly, transplants in leukemia/lymphoma patients age ‡50 years were analyzed comparing outcomes for recipients of MSD ‡50 (n 5 1415) versus MUD <50 years (n 5 757). Risks of acute graft-versus-host disease (GVHD) grade 2 to 4 (hazard ratio [HR], 1.63; P < .001), 3 to 4 (HR, 1.85; P < .001), and chronic GVHD (HR, 1.48; P < .0001) were higher after MUD compared with MSD transplants. The effect of donor type on nonrelapse mortality (NRM), relapse, and overall mortality was associated with performance score. For patients with scores of 90 or 100, NRM (HR, 1.42; P 5 .001), relapse (HR, 1.45; P < .001), and overall mortality (HR, 1.28; P 5 .001) risks were higher after MUD transplants. For patients with scores below 90, NRM (HR, 0.96; P 5 .76), relapse (HR, 0.86; P 5 .25), and overall mortality (HR, 0.90; P 5 .29) were not significantly different after MUD and MSD transplants. These data favor an MSD over a MUD in patients age ‡50 years.",
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AU - Alousi, Amin M.

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AU - Appelbaum, Frederick R.

AU - Artz, Andrew

AU - Benjamin, Jonathan

AU - Devine, Steven M.

AU - Kan, Fangyu

AU - Laughlin, Mary J.

AU - Lazarus, Hillard M.

AU - Liesveld, Jane

AU - Perales, Miguel Angel

AU - Maziarz, Richard T.

AU - Sabloff, Mitchell

AU - Waller, Edmund K.

AU - Eapen, Mary

AU - Champlin, Richard E.

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