Donor Age Matters for Haploidentical HCT Patients Even After Adjusting for HLA Factors: A Machine Learning Approach

作者：Rohtesh S. Mehta, Rodney Sparapani, Tao Wang, Stephen R. Spellman, Stephanie J. Lee, Effie W. Petersdorf · 发表于：American Journal of Hematology · 年份：2025 · DOI：10.1002/ajh.27648 · 被引用次数：4 · 研究领域：Renal Transplantation Outcomes and Treatments、Hematopoietic Stem Cell Transplantation、Blood groups and transfusion

A study by the Center for International Blood and Marrow Transplant Research (CIBMTR) assessed associations between HLA mismatching at individual loci and clinical outcomes after haploidentical donor hematopoietic cell transplantation (HCT) [1]. The HLA factors associated with superior progression-free survival (PFS) were HLA-B leader match, HLA-DRB1 mismatch, HLA-DQB1 match, and non-permissive T-cell epitope HLA-DPB1 mismatch. Although donor age was noted to be a significant predictor of overall survival, it was not identified as a risk factor for PFS; however, the study was not designed to examine the joint effects of donor age and HLA factors. An online calculator based on the PFS results is available (https://haplodonorselector.b12x.org/v1.0/) to aid in donor selection. The calculator may suggest choosing a much older donor over a younger one, for example, a 65-year-old B leader matched/DRB1 mismatched donor would be recommended over a 30-year-old HLA-B leader-mismatched/DRB1-mismatched donor. As donor age is a known predictor of survival after haploidentical donor HCT [2-6], we hypothesized that the non-significant effect of donor age on PFS in the original study might be related to categorization, not fully capturing its impact. The complexity of haploidentical HCT, where multiple predictors (donor age and relationship) are interrelated and correlated with recipient factors (age), may make it difficult to separate the impact of donor age. Therefore, we reanalyzed the pu...