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Haploidentical vs matched unrelated donors for patients with ALL: donor age matters more than donor type. Blood Adv 2023 Apr 25;7(8):1594-1603



Pubmed ID


Pubmed Central ID




Scopus ID

2-s2.0-85157975600 (requires institutional sign-in at Scopus site)   3 Citations


Haploidentical hematopoietic cell transplantation (HCT) with posttransplant cyclophosphamide (PTCy) graft-versus-host-disease (GVHD) prophylaxis yields a similar overall survival (OS) to HLA-matched unrelated donor (MUD) HCT with conventional prophylaxis. Given the prognostic implications of donor age, we investigated the impact of donor age (younger [<35 years, n = 868] vs older [≥35 years, n = 418]) and donor type (haploidentical [n = 373] vs MUD [n = 913]) on OS in adult patients with acute lymphoblastic leukemia (ALL). Older donor age was independently associated with significantly poor OS, whereas donor type was not. Next, we directly compared the outcomes of a younger haploidentical donor (n = 187) vs an older MUD (n = 232). In this cohort, more patients in the haploidentical group had B-cell immunophenotype (89% vs 77%, respectively, P < .001), poor cytogenetics (61% vs 51%, respectively, P = .44), Philadelphia chromosome-negative (53% vs 48%, respectively, P = .38), received bone marrow graft (42% vs 16%, respectively, P < .001), and reduced-intensity conditioning (45% vs 23%, respectively, P < .001). In the multivariate analysis, the older MUD group was associated with a significantly higher risk of chronic GVHD, higher nonrelapse mortality (NRM), lower relapse, and poorer OS. Despite a higher risk of relapse, younger donor haploidentical HCT with PTCy prophylaxis may be preferred over older MUD HCT with conventional prophylaxis in patients with ALL due to lower NRM and better OS. Further analysis comparing the effect of donor age in haploidentical PTCy vs MUD PTCy is warranted.

Author List

Mehta RS, Marin D, Alousi A, Kanakry CG, Champlin RE, Rezvani K, Shpall EJ, Page K, Gadalla SM, Weisdorf D, Kebriaei P


Kristin Page MD, MHS, MEd Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Graft vs Host Disease
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Unrelated Donors