Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants.
Kumar AJ, Kim S, Hemmer MT, Arora M, Spellman SR, Pidala JA, Couriel DR, Alousi AM, Aljurf MD, Cahn JY, Cairo MS, Cutler CS, Farhan S, Gergis U, Hale GA, Hashmi SK, Inamoto Y, Kamble RT, Kharfan-Dabaja MA, MacMillan ML, Marks DI, Nakasone H, Norkin M, Qayed M, Ringden O, Schouten HC, Schultz KR, Solh MM, Teshima T, Urbano-Ispizua A, Verdonck LF, Gale RP, Hamilton BK, Majhail NS, and Loren AW. Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants. Blood Adv 2018; 2(9):1022-1031.
Optimal donor selection is critical for successful allogeneic hematopoietic cell transplantation (HCT). Donor sex and parity are well-established risk factors for graft-versus-host disease (GVHD), with male donors typically associated with lower rates of GVHD. Well-matched unrelated donors (URDs) have also been associated with increased risks of GVHD as compared with matched sibling donors. These observations raise the question of whether male URDs would lead to more (or less) favorable transplant outcomes as compared with parous female sibling donors. We used the Center for International Blood and Marrow Transplant Research registry to complete a retrospective cohort study in adults with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome, who underwent T-cell replete HCT from these 2 donor types (parous female sibling or male URD) between 2000 and 2012. Primary outcomes included grade 2 to 4 acute GVHD (aGVHD), chronic GVHD (cGVHD), and overall survival. Secondary outcomes included disease-free survival, transplant-related mortality, and relapse. In 2813 recipients, patients receiving male URD transplants (n = 1921) had 1.6 times higher risk of grade 2 to 4 aGVHD (P < .0001). For cGVHD, recipient sex was a significant factor, so donor/recipient pairs were evaluated. Female recipients of male URD grafts had a higher risk of cGVHD than those receiving parous female sibling grafts (relative risk [RR] = 1.43, P < .0001), whereas male recipients had similar rates of cGVHD regardless of donor type (RR = 1.09, P = .23). Donor type did not significantly affect any other end point. We conclude that when available, parous female siblings are preferred over male URDs.
Medical Subject Headings
Adult; Allografts; Disease-Free Survival; Donor Selection; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Myelodysplastic Syndromes; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Registries; Sex Factors; Siblings; Survival Rate; Unrelated Donors