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. 2025 Apr;39(4):951-961.
doi: 10.1038/s41375-025-02538-1. Epub 2025 Feb 19.

Donor selection in T-cell-replete haploidentical donor peripheral blood stem cell transplantation

Fumiya Wada  1 , Makoto Iwasaki  1 , Masahiro Hirayama  2 , Koji Kawamura  3 , Katsuji Kaida  4 , Noriko Doki  5 , Hirohisa Nakamae  6 , Yuta Hasegawa  7 , Takahiro Fukuda  8 , Tetsuya Eto  9 , Nobuhiro Hiramoto  10 , Yumiko Maruyama  11 , Koji Nagafuji  12 , Shuichi Ota  13 , Jun Ishikawa  14 , Toshihiko Ando  15 , Tatsuo Ichinohe  16 , Yoshiko Atsuta  17   18 , Hideki Nakasone  19   20 , Junya Kanda  21
Affiliations

Donor selection in T-cell-replete haploidentical donor peripheral blood stem cell transplantation

Fumiya Wada et al. Leukemia. 2025 Apr.

Abstract

The effects of donor characteristics on outcomes after T-cell-replete (TCR) haploidentical donor peripheral blood stem cell transplantation (PBSCT) with post-transplant cyclophosphamide (PTCy) or low-dose antithymocyte globulin (ATG) remain unclear. We evaluated the impact in 1,677 patients who received a PTCy protocol (PTCy-haplo; n = 1,107) or low-dose ATG protocol (ATG-haplo; n = 570). A low CD34+ cell dose (<4 ×106/kg) was the only donor characteristic associated with worse overall survival (OS) after PTCy-haplo (adjusted hazard ratios [aHR] = 1.49, P = 0.008), whereas increasing donor age by decade (aHR = 1.12, P = 0.008) and human leukocyte antigen 2-3 antigen mismatches (aHR = 1.46, P = 0.010), compared to HLA 0-1 antigen mismatches, were associated with worse OS after ATG-haplo. Increasing donor age was associated with a high risk of grade III-IV acute GVHD both after PTCy-haplo (HR: 1.32, P = 0.009) and ATG-haplo (HR: 1.22, P = 0.006). Offspring donors had better relapse-free survival and GVHD-free relapse-free survival than sibling donors after ATG-haplo. Our data highlights the donor characteristics associated with improved transplant outcomes after TCR haploidentical donor PBSCT with PTCy or low-dose ATG.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval: This study was approved by the Data Management Committee of the Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT) and the Ethics Committee of Kyoto University (approval number: R1437). Patient consent: Informed consent was obtained from all patients.

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