Young unrelated donors confer a survival advantage for patients with myeloid malignancies compared to older siblings

Research output: Contribution to journal › Research article › Contributed › peer-review

Contributors

  • German Cooperative Transplant Study Group - (Author)
  • Department of Internal Medicine I
  • DKMS Clinical Trials Unit
  • University Hospital Frankfurt
  • Martin Luther University Hospital
  • University Medical Center Mainz
  • University Hospital Hamburg Eppendorf
  • University Hospital Tübingen
  • University Hospital Münster
  • University Hospital Essen
  • University Hospital Schleswig-Holstein Campus Kiel
  • University Hospital Aachen
  • University Hospital Augsburg
  • German Red Cross Blood Donation Service Baden-Württemberg/Hessen
  • Ulm University Medical Center

Abstract

Donor age is one factor to optimize allogeneic hematopoietic cell transplantation (alloHCT). Therefore, we investigated whether young unrelated donors (UD) provide a benefit for older patients with myeloid malignancies compared to HLA-identical sibling donors (MSD). We performed a retrospective registry study on patients ≥50 years who received a first alloHCT between 2010 and 2020. We compared event-free survival (EFS) of patients who were transplanted from MSD aged ≥50 years versus UD aged ≤35 years who were HLA-compatible for HLA-A, -B, -C, and -DRB1. In total, we analyzed data from 3460 patients. With multivariable adjustment EFS (HR 0.86, p = 0.003), OS (HR 0.82, p < 0.001), and risk of relapse (HR 0.84, p = 0.018) were significantly better for HLA-compatible UD compared to MSD. No survival advantage was found, when UD with unfavorable sex or CMV constellation were compared to MSD with favorable constellations. In a meta-analysis on 9905 patients with myeloid malignancies, including ours, we found reduced risk of relapse (pooled HR 0.78, p = 0.006) and better EFS (pooled HR 0.89, p < 0.001) for young matched UD versus MSD. To select young HLA-compatible UD over older MSD may reduce relapse risk and improve survival for older patients with myeloid malignancies.

Details

Original languageEnglish
Pages (from-to)2523-2532
Number of pages10
JournalLeukemia
Volume39
Issue number10
Publication statusPublished - Oct 2025
Peer-reviewedYes

External IDs

PubMedCentral PMC12463653
Scopus 105016601633

Keywords

Keywords

  • Humans, Male, Female, Siblings, Middle Aged, Unrelated Donors, Retrospective Studies, Adult, Hematopoietic Stem Cell Transplantation/mortality, Aged, Survival Rate, Age Factors, Transplantation, Homologous, Prognosis, Registries, Follow-Up Studies, Graft vs Host Disease/etiology