Allogeneic stem cell transplantation for older advanced MDS patients: improved survival with young unrelated donor in comparison with HLA-identical siblings

• Published in: Leukemia Vol. 27; no. 3; pp. 604 - 609
• Main Authors: Kröger, N, Zabelina, T, de Wreede, L, Berger, J, Alchalby, H, van Biezen, A, Milpied, N, Volin, L, Mohty, M, Leblond, V, Blaise, D, Finke, J, Schaap, N, Robin, M, de Witte, T
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2013; Nature Publishing Group
• Subjects: 692/699/67/1990/1673; 692/700/1518; 692/700/228; 692/700/565/545/576/1955; Adult; Age; Aged; Anemia; Antigens; Cancer Research; Care and treatment; Confidence intervals; Critical Care Medicine; Donor Selection; Female; Follow-Up Studies; Graft versus host reaction; Hematology; Histocompatibility antigen HLA; Histocompatibility testing; HLA Antigens - metabolism; Humans; Intensive; Internal Medicine; Leukemia; Leukocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Mud; Multivariate analysis; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - immunology; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Neoplasm Recurrence, Local - immunology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - therapy; Oncology; original-article; Patient outcomes; Patients; Prognosis; Remission (Medicine); Siblings; Stem Cell Transplantation; Stem cells; Survival; Survival Rate; Transplantation; Transplantation, Homologous; Unrelated Donors; Young Adult; Netherlands; France; Germany; Paris France; allogeneic stem cell transplantation; unrelated donor; donor selection; MDS; donor age
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2012.210

We investigated whether a young human leukocyte antigen (HLA)-matched unrelated donor (MUD) should be preferred as donor to an HLA-identical sibling (MRD) for older patients with myelodysplastic syndrome (MDS) (⩾50 years) who underwent allogeneic stem cell transplantation (AHSCT). Outcomes of 719 MDS patients with a median age of 58 years (range, 50–73 years) who received AHSCT from related ( n =555) or unrelated ( n =164) donors between 1999 and 2008 and reported to the European Group for Blood and Marrow Transplantation were analyzed. The median donor age of the MRD was 56 years (range: 35–78), in contrast to 34 years (range: 19–64) for the MUDs. Influence of donor’s age on survival was not observed for MRD (hazard ratio (HR): 1.01 (95% confidence interval (CI): 0.99–1.02), P =0.2), but there was a significant impact of MUD’s age on outcome (HR: 1.03 (95% CI: 1.01–1.06); P =0.02). Transplantation from younger MUDs (<30 years) had a significant improved 5-year overall survival in comparison with MRD and older MUDs (>30 years): 40% vs 33% vs 24% ( P =0.04). In a multivariate analysis, AHSCT from young MUD (<30 years) remained a significant factor for improved survival in comparison with MRD (HR: 0.65 (95% CI: 0.45–0.95), P =0.03), which should be considered in donor selection for older patients.