医学
内科学
血清状态
胃肠病学
髓系白血病
免疫学
病毒载量
人类免疫缺陷病毒(HIV)
作者
Jaime Sanz,Myriam Labopin,Goda Choi,Alexander Kulagin,Jacopo Peccatori,Jan Vydra,Péter Reményi,Jurjen Versluis,Montserrat Rovira,Didier Blaise,Hélène Labussière‐Wallet,Juan Montoro,Simona Sica,Ellen Meijer,Maija Itälä‐Remes,Nicolaas Schaap,Claude-Éric Bulabois,Simona Piemontese,Mohamad Mohty,Fabio Ciceri
出处
期刊:Blood
[American Society of Hematology]
日期:2024-03-29
标识
DOI:10.1182/blood.2023023697
摘要
There is a paucity of information on how to select the most appropriate unrelated donor (UD) in hematopoietic stem cell transplant (HSCT) using post-transplant cyclophosphamide (PTCy). We retrospectively analyzed the characteristics of 10/10 matched unrelated donors (MUD) and 9/10 mismatched unrelated donors (MMUD) that may affect transplant outcomes in patients with acute myeloid leukemia (AML) in first or second complete remission (CR1 or CR2). The primary endpoint was leukemia-free survival (LFS). Overall, 1011 patients were included with a median age of 54 years (range, 18-77). Donors had a median age of 29 years (range, 18-64); 304 (30%) were females of which 150 (15% of whole group) were donors to male recipients, and 621 (61%) were MUDs; 522 (52%) had negative cytomegalovirus (CMV-neg) serostatus of which 189 (19%) were used for CMV-neg recipients. Donor age older than 30 years had a negative impact on relapse (HR 1.38; 95% CI 1.06-1.8), LFS (HR 1.4; 95% CI 1.12-1.74), overall survival (HR 1.45; 95% CI 1.14-1.85) and GVHD-free, relapse-free survival (HR 1.29; 95% CI 1.07-1.56). Additionally, CMV-neg donor for CMV-neg recipient was associated with improved LFS (HR 0.74; 95% CI 0.55-0.99). The use of MMUD and female donors for male recipients did not significantly impact any transplant outcomes. For patients undergoing HSCT from an UD with PTCy for AML, donor age < 30 years significantly improves survival. In this context, donor age might be prioritized over HLA match considerations. In addition, CMV neg donors are preferable for CMV neg recipients. However, further research is needed to validate and refine these recommendations.
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