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<p>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; <i>n</i> = 1,107) or low-dose ATG protocol (ATG-haplo; <i>n</i> = 570). A low CD34<sup>+</sup> cell dose (&lt;4 ×10<sup>6</sup>/kg) was the only donor characteristic associated with worse overall survival (OS) after PTCy-haplo (adjusted hazard ratios [aHR] = 1.49, <i>P</i> = 0.008), whereas increasing donor age by decade (aHR = 1.12, <i>P</i> = 0.008) and human leukocyte antigen 2-3 antigen mismatches (aHR = 1.46, <i>P</i> = 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, <i>P</i> = 0.009) and ATG-haplo (HR: 1.22, <i>P</i> = 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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年2月19日

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  • Fumiya Wada,
  • Makoto Iwasaki,
  • Masahiro Hirayama,
  • Koji Kawamura,
  • Katsuji Kaida,
  • Noriko Doki,
  • Hirohisa Nakamae,
  • Yuta Hasegawa,
  • Takahiro Fukuda,
  • Tetsuya Eto,
  • Nobuhiro Hiramoto,
  • Yumiko Maruyama,
  • Koji Nagafuji,
  • Shuichi Ota,
  • Jun Ishikawa,
  • Toshihiko Ando,
  • Tatsuo Ichinohe,
  • Yoshiko Atsuta,
  • Hideki Nakasone,
  • Junya Kanda

摘要

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.