Effect of Donor Age and Donor Relatedness on Time to Allogeneic Hematopoietic Cell Transplantation in Acute Leukemia

Abstract

Relapse after allogeneic hematopoietic cell transplantation (HCT) for acute leukemia can be reduced when pursued early after first complete remission. The impact of donor age and donor relatedness on the time from diagnosis to transplant in patients with acute leukemia was examined to clarify the design of future prospective studies that can address optimal donor choice. Files of 100 consecutive patients undergoing transplantation for leukemia were reviewed. Recipients of related donors (RDs) and unrelated donors (UDs) were not significantly different in terms of recipient gender, age, underlying diagnosis, disease risk index, graft source, or donor HLA match. UDs were significantly younger than RDs (median age, 29 versus 51, P < .001). Multivariate linear regression revealed that when controlling for age of donor and recipient, the time from diagnosis to transplant was 35% longer with UDs compared with RDs (P = .018). No significant correlation was observed between donor and recipient age on length of time to transplant (P = .134 and P = .850, respectively), when controlling for other variables. The steps in UD procurement that contribute most to the longer time to transplant relate to activating the donor workup and scheduling the donor workup before cell collection. Understanding sources of delay in the transplant process will help transplant centers and UD registries reduce the time to transplant for patients with acute leukemia and will provide necessary insight for the design of prospective controlled studies that can address optimal donor choice.

Effect of donor age on adult unrelated donor haemopoietic cell transplant outcome: the Australian experience

“…17 A 2018 paper by Visram et al found that unrelated donors for HCT for acute leukaemia were significantly younger than related donors (median age, 29 vs 51; P < 0.001), indicating a continued preference for younger unrelated donors. 18 A recent paper by Perales et al compared results of HCT for AML between recipients of haploidentical donors and matched unrelated donors aged 18-40 years, and found better survival for the unrelated donors, indicating that they were preferred. 19 The present study is limited by a relatively small patient population (n = 1158), a lack of available highresolution HLA typing, and a small number of HLA mismatched donors (n = 95), making conclusive statements about the effect of HLA compatibility difficult.…”

Haploidentical Transplantation with Post-Transplant Cyclophosphamide versus Unrelated Donor Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

“…This finding is important because, from a practical standpoint, waiting for an URD for a patient with very high-risk or refractory disease is often a risky, or even unreasonable, option. Identifying a suitable URD usually takes longer than 2 months, even in high-income countries [63], which delays the transplantation procedure [64] and impairs the optimal timing for these urgent transplantations, whereas a haploidentical donor can be cleared for donation in just 2 weeks.…”

Factors associated with registrant availability for unrelated adult donor hematopoietic stem cell donation: Analysis of the stem cell registry at Canadian Blood Services

“…When registrants are no longer interested or able to donate or where registries are unable to contact registrants, transplant centers are forced to look for other donor options, which can sometimes result in less favorable matches for the patients. This can introduce delays in the transplant process, place patients at increased risk of adverse outcomes, and limit the utility of unrelated donor registries 3,4 . Identifying registrant factors associated with availability for donation and for completing the required tests for initial donor consideration allows registries to adopt changes that will enhance the utility of their registry.…”