Young unrelated donors confer a survival advantage for patients with myeloid malignancies compared to older siblings

IF 13.4 1区 医学 Q1 HEMATOLOGY
Johannes Schetelig, Henning Baldauf, Carina Rave, Gesine Bug, Lutz P. Müller, Eva Maria Wagner-Drouet, Francis Ayuketang Ayuk, Wolfgang Bethge, Matthias Stelljes, Thomas Schroeder, Friedrich Stölzel, Edgar Jost, Christoph Schmid, Desiree Kunadt, Katja Sockel, Katharina Egger-Heidrich, Jan Moritz Middeke, Daniel Fürst, Daniel Schefzyk, Jürgen Sauter, Alexander H. Schmidt, Katharina Fleischhauer, Martin Bornhäuser, on behalf of the German Cooperative Transplant Study Group, Deutsches Register für hämatopoetische Stammzelltransplantation und Zelltherapie (DRST)
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Abstract

Donor age is one factor to optimize allogeneic hematopoietic cell transplantation (alloHCT). Therefore, we investigated whether young unrelated donors (UD) provide a benefit for older patients with myeloid malignancies compared to HLA-identical sibling donors (MSD). We performed a retrospective registry study on patients ≥50 years who received a first alloHCT between 2010 and 2020. We compared event-free survival (EFS) of patients who were transplanted from MSD aged ≥50 years versus UD aged ≤35 years who were HLA-compatible for HLA-A, -B, -C, and -DRB1. In total, we analyzed data from 3460 patients. With multivariable adjustment EFS (HR 0.86, p = 0.003), OS (HR 0.82, p < 0.001), and risk of relapse (HR 0.84, p = 0.018) were significantly better for HLA-compatible UD compared to MSD. No survival advantage was found, when UD with unfavorable sex or CMV constellation were compared to MSD with favorable constellations. In a meta-analysis on 9905 patients with myeloid malignancies, including ours, we found reduced risk of relapse (pooled HR 0.78, p = 0.006) and better EFS (pooled HR 0.89, p < 0.001) for young matched UD versus MSD. To select young HLA-compatible UD over older MSD may reduce relapse risk and improve survival for older patients with myeloid malignancies.

Abstract Image

Abstract Image

与年长的兄弟姐妹相比,年轻的非亲属供体赋予骨髓恶性肿瘤患者生存优势
供体年龄是优化同种异体造血细胞移植(allogeneic hematopoietic cell transplantation, alloHCT)的一个因素。因此,我们研究了与hla相同的兄弟姐妹供体(MSD)相比,年轻的非亲属供体(UD)是否对老年髓系恶性肿瘤患者有益。我们对2010年至2020年间首次接受同种异体hct的≥50岁患者进行了回顾性登记研究。我们比较了年龄≥50岁的MSD移植患者与年龄≤35岁、HLA-A、-B、-C和-DRB1兼容的UD移植患者的无事件生存期(EFS)。我们总共分析了3460名患者的数据。多变量调整后,与MSD相比,hla相容UD的EFS (HR 0.86, p = 0.003)、OS (HR 0.82, p < 0.001)和复发风险(HR 0.84, p = 0.018)明显更好。当性别不利或CMV星座的UD与星座有利的MSD进行比较时,没有发现生存优势。在一项对9905例髓系恶性肿瘤患者(包括我们的患者)的荟萃分析中,我们发现年轻匹配的UD与MSD相比,复发风险降低(合并HR 0.78, p = 0.006), EFS更好(合并HR 0.89, p < 0.001)。选择年轻的hla兼容UD而不是老年的MSD可以降低老年髓系恶性肿瘤患者的复发风险并提高生存率。
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来源期刊
Leukemia
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
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