Mismatched Unrelated vs Matched Related Donor Transplant With Posttransplant Cyclophosphamide Among Patients With Blood Cancers

作者：Rohtesh S. Mehta, Yosra M. Aljawai, Partow Kebriaei, Warren Fingrut, Portia Smallbone, Betul Oran, Amanda Olson, Uday Popat, Richard E. Champlin, Elizabeth J. Shpall · 发表于：JAMA Network Open · 年份：2026 · DOI：10.1001/jamanetworkopen.2026.23265 · 研究领域：Hematopoietic Stem Cell Transplantation、Neutropenia and Cancer Infections、Renal Transplantation Outcomes and Treatments

Importance: Relapse limits survival after allogeneic hematopoietic cell transplant. Although human leukocyte antigen-matched related donors (MRDs) are traditionally preferred, mismatched unrelated donors (MMUDs) using posttransplant cyclophosphamide may provide stronger graft-vs-leukemia effects, potentially altering donor selection strategies. Objective: To compare outcomes between MRD and MMUD transplant in the posttransplant cyclophosphamide era and assess whether MMUD grafts are associated with lower relapse rates. Design, Setting, and Participants: This retrospective cohort study (January 1, 2017, to August 31, 2024) assessed 1038 patients with acute leukemia or myelodysplastic syndromes and/or myeloproliferative neoplasms undergoing their first peripheral blood hematopoietic cell transplant using posttransplant cyclophosphamide. The MRD cohort was from a single tertiary center, and the MMUD cohort was from the Center for International Blood and Marrow Transplant Research. Data were analyzed between January 19, 2026, and April 2, 2026. Exposure: Transplant from MRD (n = 306) vs MMUD (n = 732). Main Outcomes and Measures: Disease-free survival (DFS), overall survival (OS), relapse, nonrelapse mortality, and graft-vs-host disease (GVHD). The study used inverse probability of treatment weighting with overlap weights and bootstrapping to address structural confounding, particularly donor age. Cox proportional hazard models were used to compare outcomes between groups and con...