Effect of donor age vs. DP matching on URD donor selection
Mehta RS, Petersdorf EW, Wang T, et al. Interplay Between Donor Age and HLA-DP Matching in 10/10 HLA-Matched Unrelated Donor HCT. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2024013677).
For patients undergoing hematopoietic cell transplantation (HCT) from a 10/10 HLA-matched unrelated donor, scientists agree that the age of the donor matters more than T-cell epitope DP-matching. Within a sample of 10,783 HCT patients who received prophylaxis with calcineurin-inhibitor, investigators evaluated outcomes based on six different pairings of donor age and DP-matching. Specifically, the scenarios included DP-matched/younger donor, DP-matched/older donor, permissive-mismatched/younger donor, permissive-mismatched/older donor, non-permissive mismatched/younger donor, and non-permissive mismatched/older donor. Analysis determined that younger donor age, rather than DP-matching, correlated with better overall survival (OS). Use of donors with permissive mismatches achieved OS comparable to that observed with DP-matched donors, but the outcome favored younger donors over older ones. The research underscores the preference for DP-matched or permissive-mismatched donors younger than age 35 years. However, even in the case of non-permissive mismatches — which the study says should be avoided — OS with younger donors was better than with older donors.