Novel machine learning technique further clarifies unrelated donor selection to optimize transplantation outcomes. Blood Adv 2024 Dec 10;8(23):6082-6087
Date
10/06/2024Pubmed ID
39368807Pubmed Central ID
PMC11652765DOI
10.1182/bloodadvances.2024013756Scopus ID
2-s2.0-85212173730 (requires institutional sign-in at Scopus site)Abstract
We investigated the impact of donor characteristics on outcomes in allogeneic hematopoietic cell transplantation (HCT) recipients using a novel machine learning approach, the Nonparametric Failure Time Bayesian Additive Regression Trees (NFT BART). NFT BART models were trained on data from 10 016 patients who underwent a first HLA-A, B, C, and DRB1 matched unrelated donor (MUD) HCT between 2016 and 2019, reported to the Center for International Blood and Marrow Transplant Research, then validated on an independent cohort of 1802 patients. The NFT BART models were adjusted based on recipient, disease, and transplant variables. We defined a clinically meaningful impact on overall survival (OS) or event-free survival (EFS; survival without relapse, graft failure, or moderate to severe chronic graft-versus-host disease) as >1% difference in predicted outcome at 3 years. Characteristics with <1% impact (within a zone of indifference) were not considered to be clinically relevant. Donor cytomegalovirus, parity, HLA-DQB1, and HLA-DPB1 T-cell epitope matching fell within the zone of indifference. The only significant donor factor that associated with OS was age, in which, compared with 18-year-old donors, donors aged ≥31 years old were associated with lower OS. Both donor age (≤32 years) and use of a male donor, regardless of recipient sex, improved EFS. We, therefore, recommend selecting the earliest available donor within the 18 to 30 years age range for HCT to optimize OS. If several donors in the 18 to 30 years age range are available, a male donor may be chosen to optimize EFS.
Author List
Spellman SR, Sparapani R, Maiers M, Shaw BE, Laud P, Bupp C, He M, Devine SM, Logan BRAuthors
Purushottam W. Laud PhD Adjunct Professor in the Data Science Institute department at Medical College of WisconsinBrent R. Logan PhD Director, Professor in the Data Science Institute department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Data Science Institute department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Child
Child, Preschool
Donor Selection
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Machine Learning
Male
Middle Aged
Transplantation, Homologous
Treatment Outcome
Unrelated Donors
Young Adult
