Birth order and transplantation outcome in HLA-identical sibling stem cell transplantation: an analysis on behalf of the Center for International Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2013 May;19(5):741-5
Date
02/06/2013Pubmed ID
23380341Pubmed Central ID
PMC3864760DOI
10.1016/j.bbmt.2013.01.020Scopus ID
2-s2.0-84876313449 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
Allogeneic stem cell transplantation (SCT) is the most effective treatment option for many hematologic malignancies, but graft-versus-host disease (GVHD) remains a major cause of treatment failure. Along with well-established risk factors for transplantation outcomes, recent single-center studies have identified a birth order effect in HLA-identical sibling SCT, with lower rates of acute and chronic GVHD and improved overall survival when the donor is younger than the recipient. One hypothesized mechanism for this effect is microchimerism due to fetomaternal and transmaternal sibling cell trafficking during pregnancy as the donor is exposed to recipient antigens in utero. The aim of the present study was to validate previously reported single-center data in a large, multicenter cohort provided by the Center for International Blood and Marrow Transplantation. All adult and pediatric patients (n = 11,365) with a hematologic malignancy who underwent allogeneic SCT with a graft from an HLA-identical sibling donor between 1990 and 2007 were included. When donors were younger than recipients, there was a significantly lower rate of acute GVHD grade II-IV and chronic GVHD in children, as well as a lower rate of chronic GVHD in adolescents. However, the hypothesized overall positive effect of lower relapse and better survival when donors are younger than recipients was not observed. Our data suggest that if otherwise equally matched, a graft from a younger sibling may be superior to a graft from an older sibling for children and adolescents undergoing SCT.
Author List
Dobbelstein C, Ahn KW, Haagenson M, Hale GA, van Rood JJ, Miklos D, Waller EK, Spellman SR, Fernandez-Vina M, Ganser A, Aljurf M, Bornhaeuser M, Gupta V, Marino SR, Pollack MS, Reddy V, Eder M, Lee SJAuthor
Kwang Woo Ahn PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Birth Order
Child
Child, Preschool
Chimerism
Cohort Studies
Female
Graft vs Host Disease
HLA-DP Antigens
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Siblings
Tissue Donors
Transplantation, Homologous
Treatment Outcome
Young Adult
