The haploidentical donor is diverse and an optimal donor is critical for the survival of patients undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Under anti-thymocyte (ATG) or post-transplant cyclophosphamide (PTCy) alone-based graft-versus-host disease (GVHD) prophylaxis for haplo-HSCT, young male donor is always preferred due to a lower non-relapse mortality (NRM) and better survival, while mother or collateral relative donor is usually the last resort. The combination regimens of anti-thymocyte (ATG) and post-transplant cyclophosphamide (PTCy) in haplo-HSCT were more and more utilized due to their promising efficiencies for graft-versus-host disease (GVHD) prophylaxis, however, the impact of different donors on patient outcomes under the combination regimens remains to be unclear. Therefore, we performed a retrospective study for patients undergoing haplo-HSCT with a low-dose ATG plus low-dose PCTy-based regimen for GVHD prophylaxis at our center. The study enrolled 262 patients, whose donors were categorized into the young male donor group (age <30 years, n=74), non-parous female donor group (n=25), older male donor group (age ≥30 years, n=117), and parous female donor group (n=46). For the whole cohort, the cumulative incidences (CIs) of grade Ⅱ-Ⅳ acute GVHD (aGVHD) at 180 days and moderate-to-severe chronic GVHD at 2 years after transplantation were 11.45% (95% CI, 7.95%-15.65%) and 19.04% (95% CI, 14.38%-24.22%). In multivariate analysis, the parous female donor had a strong trend to increase the risk of grade Ⅱ-Ⅳ aGVHD (HR, 3.32, 95% CI, 0.99-11.10; P=0.051) and significantly decreased the risk of relapse (HR, 0.14, 95% CI, 0.03-0.63; P=0.010). In the parous female donor group, the 2-year OS, and RFS were relatively higher with both of 73.37% (95% CI, 61.49%-87.54%). The results suggested that the parous female donors could reduce the risk of relapse and might improve survival under the combination regimen for GVHD prophylaxis.

Disclosures

No relevant conflicts of interest to declare.

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2024
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