Who is the best donor for a related HLA haplotype-mismatched transplant?

• Published in: Blood Vol. 124; no. 6; pp. 843 - 850
• Main Authors: Wang, Yu, Chang, Ying-Jun, Xu, Lan-Ping, Liu, Kai-Yan, Liu, Dai-Hong, Zhang, Xiao-Hui, Chen, Huan, Han, Wei, Chen, Yu-Hong, Wang, Feng-Rong, Wang, Jing-Zhi, Chen, Yao, Yan, Chen-Hua, Huo, Ming-Rui, Li, Dan, Huang, Xiao-Jun
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 07.08.2014
• Subjects: Adult; Donor Selection; Female; Graft vs Host Disease - etiology; Graft vs Host Disease - immunology; Graft vs Host Disease - prevention & control; Haplotypes; Hematologic Neoplasms - immunology; Hematologic Neoplasms - therapy; Histocompatibility Testing; HLA Antigens; Humans; Kaplan-Meier Estimate; Living Donors; Male; Middle Aged; Parents; Siblings; Transplantation - mortality; Transplantation Immunology; Treatment Outcome; Young Adult
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2014-03-563130

The best donor for a related donor for a human leukocyte antigen (HLA) haplotype-mismatched transplant for hematological neoplasms is controversial. We studied outcomes in 1210 consecutive transplant recipients treated on a uniform protocol. Younger donors and male donors were associated with less nonrelapse mortality (NRM; hazard ratio [HR] = 0.30; 95% confidence interval [CI] = 0.01-0.39; P = .008 and HR = 0.65; 95% CI = 0.49-0.85; P = .002) and better survival (HR = 0.73; 95% CI = 0.54-0.97; P = .033 and HR = 0.73; 95% CI = 0.59-0.91; P = .005). Father donors were associated with less NRM (HR = 0.65; 95% CI = 0.45-0.95; P = .02), acute graft-versus-host disease (GVHD) (HR = 0.69; 95% CI = 0.55-0.86; P = .001), and better survival (HR = 0.66; 95% CI = 0.50-0.87; P = .003) compared with mother donors. Children donors were associated with less acute GVHD than sibling donors (HR = 0.57; 95% CI = 0.31-0.91; P = .01). Older sister donors were inferior to father donors with regard to NRM (HR = 1.87; 95% CI = 1.10-3.20; P = .02) and survival (HR = 1.59; 95% CI = 1.05-2.40; P = .03). Noninherited maternal antigen-mismatched sibling donors were associated with the lowest incidence of acute GVHD compared with parental donors and noninherited paternal antigen-mismatched sibling donors. Specific HLA disparities were not significantly correlated with transplant outcomes. Our data indicate which HLA haplotype-mismatched related donors are associated with the best transplant outcomes in persons with hematological neoplasms. •There is a need to identify the best HLA haplotype-mismatched related donor.•Use of young, male, NIMA-mismatched donors results in the best survival after HLA haplotype-mismatched related donor transplants.