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Donor age determines outcome in acute leukemia patients over 40 undergoing haploidentical hematopoietic cell transplantation
Author(s) -
Canaani Jonathan,
Savani Bipin N.,
Labopin Myriam,
Huang XiaoJun,
Ciceri Fabio,
Arcese William,
Koc Yener,
Tischer Johanna,
Blaise Didier,
Gülbas Zafer,
Van Lint Maria Teresa,
Bruno Benedetto,
Mohty Mohamad,
Nagler Ar
Publication year - 2018
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.24963
Subject(s) - medicine , hazard ratio , acute leukemia , transplantation , leukemia , myeloid leukemia , hematopoietic stem cell transplantation , confidence interval , oncology , gastroenterology
Haploidentical hematopoietic cell transplantation (haplo‐HCT) is being increasingly used in acute leukemia patients as an alternative transplant modality when matched sibling or matched unrelated donors are unavailable. As several potential haploidentical relative donors are typically available for a given patient, optimizing donor selection to improve clinical outcome is crucial. The impact of donor age and kinship on the outcome of acute leukemia patients is not clearly established in this setting. Using the multinational registry of the acute leukemia working party of the European society for blood and marrow transplantation we retrospective analyzed the clinical outcome of 1270 acute myeloid leukemia and acute lymphoblastic leukemia patients who underwent haplo‐HCT between 2005 and 2015. Patients over the age of 40 were significantly affected by increasing donor age resulting in higher non‐relapse mortality (NRM) [Hazard ratio (HR)=1.86, confidence interval (CI) 95%, 1.18‐2.94; P = .007], inferior leukemia‐free survival (LFS) (HR = 1.59, CI 95%, 1.13‐2.24; P = .007), and overall survival (OS) (HR = 1.74, CI 95%, 1.22‐2.47; P = .002) when donors were over the age of 40. Additionally, kinship was found to be prognostically significant as patients transplanted from children donors over the age of 35 experienced an increased rate of NRM (HR = 1.82, CI 95%, 1.13‐2.9; P = .01), inferior LFS (HR = 1.5, CI 95%, 1.05‐2.13; P = .03), and OS (HR = 1.5, CI 95%, 1.04‐2.15; P = .03). For patients younger than 40 years, donor age and kinship were mostly not clinically impactful. Our data establish donor age and kinship as significant determinants of outcome following haplo‐HCT for acute leukemia patients.