Unrelated Donor Age and Recipient Outcomes After Posttransplant Cyclophosphamide vs Conventional Prophylaxis

作者：Rohtesh S. Mehta, Rodney Sparapani, Christopher G. Kanakry, Shannon R. McCurdy, Jennifer N. Saultz, Aleksandr Lazaryan, Filippo Milano, S J Lee · 发表于：JAMA Oncology · 年份：2025 · DOI：10.1001/jamaoncol.2025.4551 · 被引用次数：9 · 研究领域：Renal Transplantation Outcomes and Treatments、Hematopoietic Stem Cell Transplantation、Organ Transplantation Techniques and Outcomes

Importance: Advanced age in unrelated donors (URDs) is a well-established risk factor in allogeneic hematopoietic cell transplant (HCT), leading registries to prioritize younger donors. However, this paradigm relevance is uncertain in the era of posttransplant cyclophosphamide (PTCy) for graft-vs-host disease (GVHD) prophylaxis, a strategy increasingly adopted for its effectiveness. Clarifying this association is crucial for optimizing donor selection and potentially expanding the donor pool. Objective: To determine whether the association of older URD age with overall survival differs between patients receiving PTCy-based vs conventional calcineurin inhibitor (CNI)-based GVHD prophylaxis. Design, Setting, and Participants: This was a multicenter cohort study using registry data from the Center for International Blood and Marrow Transplant Research for January 2017 through June 2021. Eligible participants were adult patients with acute leukemia or myelodysplastic syndrome who underwent an allogeneic HCT from a URD who was fully matched for 8 of 8 human leukocyte antigen loci (MUD) or mismatched for 7 of 8 human leukocyte antigen loci (MMUD). Data were analyzed from January to June 2025. Exposures: GVHD prophylaxis regimen (PTCy-based vs CNI-based) and donor age (analyzed continuously and categorically). Main Outcomes and Measures: Overall survival was the primary outcome, with associations assessed using a multipronged approach including least absolute shrinkage and selection...