Effect of donor characteristics on T cell-replete haploidentical stem cell transplantation over the last 10 years at a single institution

One of the most complex issues with haploidentical stem cell transplantation (haplo-SCT) is donor selection, given that multiple haploidentical donors are often available for a given recipient. To develop evidence-based guidance for donor selection in the setting of anti-thymocyte globulin-based haplo-SCT, we performed a prospective cohort study of 512 patients with haematological malignancies who had haplo-SCT to determine which donor variables were most important in favouring transplant outcomes. Increasing donor age was associated with poorer overall survival (OS) [hazard ratio (HR) 1 center dot 08, P = 0 center dot 044]. Female donors to male recipients was significantly associated with higher non-relapse mortality (NRM; HR 2 center dot 05, P = 0 center dot 006). Furthermore, increasing donor age had a higher risk of Grades 3-4 acute graft-versus-host disease (aGVHD; HR 1 center dot 17, P = 0 center dot 005), female donors to male recipients was associated with a higher risk of Grades 2-4 aGVHD (HR 1 center dot 50, P = 0 center dot 022). Sibling donors had superior OS, disease-free survival, and NRM than parental donors in patients aged <35 years. However, sibling donors had higher NRM than offspring donors in patients aged >= 35 years. A younger donor, usually a young sibling in younger recipients (aged <35 years) or a young offspring in older patients (aged >= 35 years) and avoiding female donors to male recipients should be preferred when multiple haploidentical donors are available.