Impact of the combination of donor age and HLA disparity on the outcomes of unrelated bone marrow transplantation

被引：0
作者：
Sachiko Seo
Yoshiaki Usui
Keitaro Matsuo
Yoshiko Atsuta
Aiko Igarashi
Takahiro Fukuda
Yukiyasu Ozawa
Yuta Katayama
Shuro Yoshida
Naoyuki Uchida
Tadakazu Kondo
Shinichi Kako
Nobuhiro Tsukada
Shunichi Kato
Makoto Onizuka
Tatsuo Ichinohe
Fumihiko Kimura
Yoshinobu Kanda
Koichi Miyamura
Junya Kanda
机构：
[1] Dokkyo Medical University,Department of Hematology and Oncology
[2] Aichi Cancer Center Research Institute,Division of Cancer Information and Control
[3] Aichi Cancer Center Research Institute,Division of Cancer Epidemiology and Prevention
[4] Nagoya University Graduate School of Medicine,Department of Cancer Epidemiology
[5] Japanese Data Center for Hematopoietic Cell Transplantation,Department of Healthcare Administration
[6] Nagoya University Graduate School of Medicine,Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center
[7] Komagome Hospital,Department of Hematopoietic Stem Cell Transplantation
[8] National Cancer Center Hospital,Department of Hematology
[9] Japanese Red Cross Nagoya First Hospital,Department of Hematology
[10] Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital,Department of Hematology
[11] Hamanomachi Hospital,Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations
[12] Toranomon Hospital,Department of Hematology and Oncology
[13] Kyoto University,Division of Hematology
[14] Jichi Medical University Saitama Medical Center,Department of Hematology
[15] Japanese Red Cross Medical Center,Department of Innovative Medical Science
[16] Tokai University School of Medicine,Department of Hematology/Oncology
[17] Tokai University School of Medicine,Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine
[18] Hiroshima University,Division of Hematology
[19] National Defense Medical College,Division of Hematology
[20] Jichi Medical University,undefined
[21] Matsue Red Cross Hospital,undefined
[22] Otaru General Hospital,undefined
[23] Kyushu University Hospital,undefined
[24] Nagoya University Hospital,undefined
[25] Anjo Kosei Hospital,undefined
[26] National Hospital Organization Okayama Medical Center,undefined
[27] Kanagawa Cancer Center,undefined
[28] Hamamatsu University Hospital,undefined
[29] Showa University Fujigaoka Hospital,undefined
[30] National Center for Child Health and Development,undefined
[31] Nova Biomedical,undefined
[32] Aichi Medical University Hospital,undefined
[33] Kobe University Hospital,undefined
[34] Meitetsu Hospital,undefined
[35] Kanazawa University Hospital,undefined
[36] Kurume University Hospital,undefined
[37] Japanese Red Cross Society,undefined
[38] National Hospital Organization Nagoya Medical Center,undefined
[39] Kyoto University Hospital,undefined
[40] Tokyo Medical University Hospital,undefined
[41] The Institute of Medical Science,undefined
[42] The University of Tokyo,undefined
[43] University of Tsukuba Hospital,undefined
[44] Tottori University Hospital,undefined
[45] Iwaki Central Hospital,undefined
[46] Ibaraki Children’s Hospital,undefined
[47] Kyusyu Hospital,undefined
[48] St. Marianna University Hospital,undefined
[49] Jichi Medical University,undefined
[50] Kitakyusyu City Yahata Hospital,undefined
来源：
Bone Marrow Transplantation | 2021年 / 56卷
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摘要：
Impact of donor age considering HLA disparity on hematopoietic cell transplantation (HCT) outcomes has not been fully evaluated. We evaluated 8486 patients who received unrelated bone marrow transplantation (UR-BMT) from 8/8 or 7/8 HLA-matched donors. Compared to 8/8 HLA-matched younger donors (<40 years), 8/8 HLA-matched older donors (subdistribution hazard ratio [SHR], 1.16; 95% CI, 0.97–1.38) and 7/8 HLA-matched younger donors (SHR, 1.33; 95% CI, 1.11–1.58) were associated with increased risk of grade III–IV acute graft-versus-host disease (aGVHD). 7/8 HLA-matched older donors had further increased risk (SHR, 2.00; 95% CI, 1.68–2.38) due to interaction between donor age and HLA disparity (p for interaction = 0.038). Progression-free survival (PFS) after UR-BMT with 8/8 HLA-matched younger donors was comparable to that after UR-BMT with 8/8 HLA-matched older donors, whereas UR-BMT with 7/8 HLA-matched younger or older donors was significantly associated with lower PFS than UR-BMT with 8/8 HLA-matched younger donors (younger donor; HR, 1.12; 95% CI, 1.04–1.21, older donor; HR, 1.28; 95% CI, 1.17–1.40; p for interaction = 0.079). In conclusion, adverse effect of increased donor age requires attention, especially in HLA-mismatched UR-BMT due to interaction between donor age and HLA disparity. Intensive aGVHD prophylaxis may be required to improve outcomes after HCT with mismatched older donors.
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页码：2410 / 2422
页数：12
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