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Montoro J, Eikema DJ, Tuffnell J, Potter V, Kałwak K, Halkes CJJ, Kulagin A, Collin M, Wynn RF, Robinson S, Nicholson E, Sengeloev H, Halahleh K, Skorobogatova E, Sanz J, Passweg JR, Mielke S, Ryhänen SJ, Carpenter B, Gedde-Dahl T, Tholouli E, Fanin R, Lewalle P, Kulasekararaj AG, Risitano AM, Peffault de Latour R. Alternative donor transplantation for severe aplastic anemia: a comparative study of the SAAWP EBMT. Blood 2024:blood.2024024173. [PMID: 38643511 DOI: 10.1182/blood.2024024173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Selecting the most suitable alternative donor becomes challenging in severe aplastic anemia (SAA) when a matched sibling donor (MSD) is unavailable. We compared outcomes in SAA patients undergoing SCT from matched unrelated donors (MUD, n=1106), mismatched unrelated donors (MMUD, n=340), and haploidentical donors (Haplo, n=206) registered in the EBMT database (2012-2021). For Haplo-SCT, only those receiving post-transplant cyclophosphamide (PT-Cy) for graft-versus-host disease (GVHD) prophylaxis were included. Median age was 20 years, and the median time from diagnosis to transplantation 8.7 months. Compared to MUD, MMUD (HR, 2.93; 95% CI, 1.52-5.6) and Haplo (HR, 5.15; 95% CI, 2.5-10.58) showed significantly higher risks of primary graft failure. MUD had lower rates of acute GVHD compared to MMUD and Haplo, grade II-IV (13%, 22%, and 19%, respectively, p<0.001) and III-IV (5%, 9%, and 7%, respectively, p=0.028). The 3-year non-relapse mortality was 14% for MUD, 19% for MMUD, and 27% for Haplo (p<0.001), while overall survival (OS) and GVHD and relapse-free survival (GRFS) were 81% and 73% for MUD, 74% and 65% for MMUD, and 63% and 54% for Haplo, respectively (p<0.001). In addition to donor type, multivariable analysis identified other factors like patient age, performance status, and interval between diagnosis and transplant associated with GRFS. For SAA patients lacking an MSD, our findings support MUD transplantation as the preferable alternative donor. However, selecting between a MMUD or Haplo donor remains uncertain and requires further exploration.
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Affiliation(s)
- Juan Montoro
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | - Matthew Collin
- Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Robert F Wynn
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Emma Nicholson
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Stephan Mielke
- Karolinska Institute & University Hospital, Stockholm, Sweden
| | - Samppa Johannes Ryhänen
- University of Helsinki and Helsinki University Hospital, ChildrenÂ's Hospital, and Pediatric Research Center, Helsinki, Finland
| | | | | | | | | | - Philippe Lewalle
- institut jules Bordet uUiversite Libre de Bruxelles, Brussels, Belgium
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