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

• Main Author: Paz, Alessandra Aparecida
• Publication Date: 2018
• Other Authors: Rigoni, Lisandra Della Costa, Fischer, Gustavo Brandão, Schittler, Monise Luciane Paz, Silva, Annelise Martins Pezzi da, Valim, Vanessa de Souza, Gonçalves, Alice Dahmer, Zambonato, Bruna Pochmann, Amorin, Bruna, Sehn, Filipe, Silva, Maria Aparecida da, Daudt, Liane Esteves, Silla, Lucia Mariano da Rocha
• Format: Article
• Language: eng
• Source: Repositório Institucional da UFRGS
• Download full: http://hdl.handle.net/10183/204368
• topic: Doença enxerto-hospedeiro; Transplante de células-tronco; Hematopoietic stem cell transplantation; HSCT; Graft-versus-host disease; GVHD

Background: Hematopoietic 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. Objective: To 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. Results: Three 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. Conclusions: In 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.