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<p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment for myelodysplastic neoplasms (MDS). While matched sibling donors (MSD) have traditionally been preferred, the impact of donor type on transplant outcomes under anti-thymocyte globulin (ATG)-based graft-versus-host disease (GVHD) prophylaxis remains unclear. We analyzed 391 adult MDS patients receiving allo-HSCT with fludarabine–busulfan conditioning and ATG between 2009 and 2019. Donors included MSD (<i>n</i> = 155), unrelated donors (UD; <i>n</i> = 134), and haploidentical donors (HID; <i>n</i> = 102). At a median follow-up of 108 months, the 5-year overall survival (OS) and relapse-free survival (RFS) rates were 63.0% and 58.4%. While OS and non-relapse mortality (NRM) did not significantly differ by donor type, MSD recipients had a higher cumulative incidence of relapse compared to UD and HID recipients (34.3% vs. 16.4% and 16.8% at 5 years, <i>p</i> &lt; 0.001), with a trend toward inferior RFS. In multivariate analysis, MSD was independently associated with increased relapse risk and a lower incidence of GVHD, which may reflect a reduced graft-versus-leukemia effect. In this single-center large cohort, MSD transplants were associated with higher relapse risk compared with alternative donors under ATG-based prophylaxis.</p>

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Donor type and post-transplant outcomes in anti-thymocyte globulin based allogeneic transplantation for myelodysplastic syndromes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月21日

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  • So Yeon Park,
  • Hyeji Lee,
  • Daehun Kwag,
  • Gi June Min,
  • Sung Soo Park,
  • Jae-Ho Yoon,
  • Sung-Eun Lee,
  • Byung Sik Cho,
  • Ki-Seong Eom,
  • Hee-Je Kim,
  • Chang-Ki Min,
  • Seok-Goo Cho,
  • Silvia Park,
  • Yoo-Jin Kim

摘要

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative treatment for myelodysplastic neoplasms (MDS). While matched sibling donors (MSD) have traditionally been preferred, the impact of donor type on transplant outcomes under anti-thymocyte globulin (ATG)-based graft-versus-host disease (GVHD) prophylaxis remains unclear. We analyzed 391 adult MDS patients receiving allo-HSCT with fludarabine–busulfan conditioning and ATG between 2009 and 2019. Donors included MSD (n = 155), unrelated donors (UD; n = 134), and haploidentical donors (HID; n = 102). At a median follow-up of 108 months, the 5-year overall survival (OS) and relapse-free survival (RFS) rates were 63.0% and 58.4%. While OS and non-relapse mortality (NRM) did not significantly differ by donor type, MSD recipients had a higher cumulative incidence of relapse compared to UD and HID recipients (34.3% vs. 16.4% and 16.8% at 5 years, p < 0.001), with a trend toward inferior RFS. In multivariate analysis, MSD was independently associated with increased relapse risk and a lower incidence of GVHD, which may reflect a reduced graft-versus-leukemia effect. In this single-center large cohort, MSD transplants were associated with higher relapse risk compared with alternative donors under ATG-based prophylaxis.