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Comparative Study
. 2025 Jul 22;9(14):3469-3478.
doi: 10.1182/bloodadvances.2024014858.

Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis

Karthik Nath  1   2 , Mei-Jie Zhang  3 , Matthew Bye  4 , Muhammad Bilal Abid  5 , Cara Benjamin  6 , Brian Betts  7 , Neel S Bhatt  8   9 , Esteban Arrieta Bolaños  10 , Yung-Tsi Bolon  11 , Shahinaz M Gadalla  12 , Michael R Grunwald  13 , Maxwell M Krem  14 , Stephanie J Lee  4   9 , Steven G E Marsh  15 , Rodrigo Martino  16 , Parinda A Mehta  17 , Filippo Milano  9 , Timothy Prestidge  18 , Jennifer N Saultz  19 , Bronwen E Shaw  4 , Stephen R Spellman  11 , Hannah Choe  20 , Brian C Shaffer  1
Affiliations
Comparative Study

Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis

Karthik Nath et al. Blood Adv. .

Abstract

Whether older HLA-matched sibling donors (MSD) are preferred over younger alternative donors for allogeneic hematopoietic cell transplantation (allo-HCT) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is unclear. We compared outcomes in allo-HCT recipients ≥50 years old after HCT from an older MSD (≥50 years) with recipients of younger (≤35 years) HLA-matched unrelated donor (MUD), haploidentical related donor (haplo), and HLA-mismatched unrelated donor (MMUD), grouped based on PTCy or calcineurin-inhibitor (CNI) based GVHD prophylaxis, that were reported to the Center for International Blood and Marrow Transplant Research between 2014 and 2021. The primary end point was overall survival (OS). Among 14 662 HCT recipients, 3746 received PTCy- and 10 916 CNI-based prophylaxis. In patients receiving PTCy-based HCT, the adjusted 5-year OS was similar between MSD and other donor types: 44% after MSD versus 52% after MUD (multivariable hazard ratio [HR]: 1.20; 95% confidence interval [CI], 1.03-1.41; P = .09), 45% after haplo donor (HR, 1.02; 95% CI, 0.88-1.18; P = 1.00), and 46% after MMUD (HR, 1.00; 95% CI, 0.83-1.21; P = 1.00). Compared with MSD, use of MUD associated with improved disease-free survival (DFS) with PTCy-based (HR, 1.21; 95% CI, 1.05-1.40; P = .048) and CNI-based (HR, 1.09; 95% CI, 1.04-1.15; P < .01) prophylaxis. Haplo donor use associated with worse OS compared with MUD use with PTCy (HR, 1.18; 95% CI, 1.05-1.33; P = .04). Older MSDs result in similar OS compared with younger alternative donors; however, use of a younger MUD associated with improved DFS in older-aged recipients.

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Conflict of interest statement

Conflict-of-interest disclosure: J.N.S. reports research funding through an American Society of Hematology scholar award and a Kuni Foundation Imagination award; and an advisory role with Regal and Sanofi. B.C.S. reports consulting for Hansa Biopharma. H.C. reports consulting for Sanofi, Incyte, Actinium, Ironwood, REGiMMUNE, and AbbVie, and research funding from Incyte and GlaxoSmithKline. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Adjusted outcomes in patients treated with PTCy. (A) OS by donor group. (B) DFS. (C) Cumulative incidences of NRM. (D) Cumulative incidences of relapse.
Figure 2.
Figure 2.
Adjusted outcomes in patients treated with CNI. (A) OS by donor group. (B) DFS. MSD, older-aged matched, sibling donor; MUD, young matched unrelated donor.
See this image and copyright information in PMC

Comment in

References

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