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

IF 12.8 1区医学 Q1 HEMATOLOGY

Leukemia Pub Date : 2025-02-19 DOI:10.1038/s41375-025-02538-1

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

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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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t细胞单倍体外周血干细胞移植的供体选择

供体特征对移植后使用环磷酰胺（PTCy）或低剂量抗胸腺细胞球蛋白（ATG）进行t细胞填充（TCR）单倍体供体外周血干细胞移植（PBSCT）后预后的影响尚不清楚。我们评估了1,677名接受PTCy方案的患者的影响(PTCy-haplo；n = 1107)或低剂量ATG方案(ATG-haplo；n = 570)。低CD34+细胞剂量（<4 ×106/kg）是唯一与PTCy-haplo后总生存率（OS）较差相关的供体特征（校正风险比[aHR] = 1.49, P = 0.008），而与HLA 0-1抗原错配相比，供体年龄增加10岁（aHR = 1.12, P = 0.008）和人白细胞抗原2-3抗原错配（aHR = 1.46, P = 0.010）与ATG-haplo后OS较差相关。供者年龄的增加与PTCy-haplo （HR: 1.32, P = 0.009）和ATG-haplo （HR: 1.22, P = 0.006）后III-IV级急性GVHD的高风险相关。ATG-haplo后，后代供者的无复发生存率和gvhd无复发生存率优于兄弟姐妹供者。我们的数据强调了在TCR单倍体相同供体PBSCT加PTCy或低剂量ATG后，供体特征与移植结果的改善相关。

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来源期刊

Leukemia 医学-血液学

CiteScore

18.10

自引率

3.50%

发文量

270

审稿时长

3-6 weeks

期刊介绍： Title: Leukemia Journal Overview: Publishes high-quality, peer-reviewed research Covers all aspects of research and treatment of leukemia and allied diseases Includes studies of normal hemopoiesis due to comparative relevance Topics of Interest: Oncogenes Growth factors Stem cells Leukemia genomics Cell cycle Signal transduction Molecular targets for therapy And more Content Types: Original research articles Reviews Letters Correspondence Comments elaborating on significant advances and covering topical issues