Faculty Collaboration Database

Optimizing Haploidentical Donor Selection for Pediatric Hematopoietic Cell Transplant. J Clin Oncol 2026 Apr 10;44(11):1003-1015

Date

02/25/2026

Pubmed ID

41740085

Pubmed Central ID

PMC13162296

DOI

10.1200/JCO-25-01591

Scopus ID

2-s2.0-105034223811 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

PURPOSE: Critical guidance on selecting haploidentical donors for pediatric patients is lacking. It is unclear whether parents, siblings, and extended family affect acute and chronic graft-versus-host disease (aGVHD and cGVHD) differently.

METHODS: We analyzed 1,069 pediatric (<19 years) recipients of hematopoietic cell transplant during 2013-2019. Primary end points were aGVHD frequency at 100 days and cumulative incidence of cGVHD at 2 years, assessed by donor age (<18 years, 18-35, >35 years) and donor relationship, with multivariable analysis.

RESULTS: Donor age: Increased grade II-IV aGVHD occurred with older donors: >35 years (31%, odds ratio [OR], 1.7 [95% CI, 1.0 to 2.8]; P = .05) and 18-35 years (23%, OR, 2.5 [95% CI, 1.5 to 4.2]; P = .0003), versus < 18 years (15%, reference OR, 1). Increased cGVHD occurred in older donors: >35 years (incidence 30% [95% CI, 28 to 32]; hazard ratio [HR], 2.2 [95% CI, 1.3 to 3.9]; P = .004) and 18-35 years (incidence 26% [95% CI, 23 to 29]; HR, 2.1 [95% CI, 1.3 to 3.5]; P = .0028) compared with <18 years (incidence 16% [95% CI, 12 to 20]; reference HR, 1). Donor relationship: Patients with parental donors had higher aGVHD risk than siblings (mother: OR, 1.9 [95% CI, 1.3 to 2.8]; P = .001; father: OR, 1.7 [95% CI, 1.1 to 2.5]; P = .009). Patients with maternal donors had a significantly higher risk of cGVHD than paternal (HR, 2.3 [95% CI, 1.6 to 3.3]; P < .0001) and sibling donors (HR, 2.3 [95% CI, 1.7 to 3.4]; P < .0001). Age-relationship interaction: Maternal donors were associated with more GVHD than siblings, regardless of age (aGVHD II-IV, mothers >35 years, HR, 2.53 [95% CI, 1.46 to 4.41]; mothers 18-35 years, HR, 2.05 [95% CI, 1.14 to 3.69]) (cGVHD: mothers >35 years, HR, 3.10 [95% CI, 1.72 to 5.60]; mothers 18-35 years, HR, 3.35 [95% CI, 1.8 to 6.25]).

CONCLUSION: Donors <18 years are associated with reduced aGVHD and cGVHD, whereas maternal donors are associated with increased cGVHD risk. For pediatric patients, sibling donors should be considered to reduce GVHD.

Author List

Liberio N, Allbee-Johnson M, Ahn KW, Moskop A, Phelan R, Shaw BE, Page KM, Schultz KR, Phillips CL, Mehta PA, Qayed M, Sharma A, Lipsitt AE, Symons H, Bolaños-Meade J, Kharbanda S, Dvorak CC, Kapoor N, Doherty EE, Chavan RS, Broglie L

Authors

Kwang Woo Ahn PhD Director, Professor in the Data Science Institute department at Medical College of Wisconsin
Larisa Broglie MS, MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Nicole D. Liberio MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Amy Moskop MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Rachel A. Phelan MPH, MD Professor in the Pediatrics department at Medical College of Wisconsin
Bronwen E. Shaw PhD, MD Center Director, Professor in the Medicine department at Medical College of Wisconsin

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

Adolescent
Adult
Age Factors
Child
Child, Preschool
Donor Selection
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Infant
Male
Risk Factors
Siblings
Transplantation, Haploidentical
Young Adult