Donor characteristics and hematopoietic stem cell transplantation outcome: experience of a single center in Southern Brazil

Abstract

BackgroundHematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor–recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome.ObjectiveTo evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center.ResultsThree hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1–61) and 33 (range: 3–65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1–29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11–2.24; p-value = 0.013) were associated with higher transplant-related mortality.ConclusionsIn transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible.

The use of micro-costing in an economic analysis of allogeneic HSCT in Brazil

“…Other studies from the same public institution where our patients came from also reported long hospitalization time and long time between diagnosis and HSCT (>12 months) for patients with low socioeconomic status (Paz et al, 2018;Pitombeira et al, 2013;Silla et al, 2009). Since the limitation in the number of hospital beds for performing HSCT in Brazil, patients with indications for transplantation and with a donor located remain on a waiting list until bed availability (Rodrigues et al, 2020).…”

Donor Age and Non-Relapse Mortality: Study of Their Association after HLA-Matched Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndrome

“…Later studies, mostly reporting data with peripheral blood stem cell transplants, reported either no association of DA with transplant outcomes or even better outcomes with older donors (MRD, mostly), with recommendations not to take donor age into account for aHCT in elderly patients with AML [ 7 , 11 , 16 , 17 , 18 ]. In the more recently published literature, younger DA was again being proven to be associated with better survival due to lower incidences of GVHD and NRM [ 10 , 12 , 19 , 20 ]. The different results looking at the relationship between DA and the outcomes of aHCT may be explained by changes in the graft source over time (marrow to peripheral blood grafts), different GVHD prophylaxis (e.g., in vivo T-cell depletion being more common in recent years) and better donor selection (high-resolution HLA typing for MUD).…”

Cryptococcosis in Hematopoietic Stem Cell Transplant Recipients: A Rare Presentation Warranting Recognition

“…As cryptococcosis is rare among HSCT recipients, it is not possible to determine the basis for the roughly equal prevalence of this presentation among male and female patients. Yet, the slightly higher frequency of male patients among allogenic recipients could be explained considering that from patients submitted to allogenic HSCT, around 60% are male recipients, as shown in large-scale cohorts studies [ 35 , 37 , 38 ].…”