- Daniel Fürst1,
- Dietger Niederwieser2,
- Donald Bunjes3,
- Eva M. Wagner4,
- Martin Gramatzki5,
- Gerald Wulf6,
- Carlheinz R. Müller7,
- Christine Neuchel1,
- Chrysanthi Tsamadou1,
- Hubert Schrezenmeier1 and
- Joannis Mytilineos1,*
- 1 Institute for Clinical Transfusion Medicine Ulm, Germany;
- 2 Department of Hematology/Oncology, University of Leipzig, Germany;
- 3 Department of Internal Medicine III, University of Ulm, Germany;
- 4 Department of Medicine III, Johannes Gutenberg-University Mainz, Germany;
- 5 2nd Department of Medicine, University of Kiel, Germany;
- 6 Department of Hematology/Oncology, Georg-August-University Gottingen, Germany;
- 7 ZKRD - Zentrales Knochenmarkspender-Register fur Deutschland, Germany
- ↵* Corresponding author; email:
We investigated a possible interaction between age-associated risk and HLA-mismatch associated risk on prognosis in different age categories of recipients of unrelated hematopoietic stem cell transplants (HSCT) (n=3019). Patients over 55 years of age transplanted with 8/10 donors showed a mortality risk of 2.27 (CI 1.70-3.03, p<0.001) and 3.48 (CI 2.49-4.86, p<0.001) when compared to 10/10 matched patients in the same age group and to 10/10 matched patients aged 18-35 years, respectively. Compared to 10/10 matched transplantations within each age category, the HR for 8/10 matched transplantation was 1.14, 1.40 and 2.27 in patients aged 18-35 years, 36-55 and above 55 years. Modelling age as continuous variable showed different levels of risk attributed to age at the time of transplantation (OS: 10/10: HR 1.015 (per life year); 9/10: HR: 1.019; 8/10: HR 1.026). The interaction term was significant for 8/10 transplantations (p=0.009). Findings for disease free survival and transplant-related mortality were similar. Statistical models were stratified for diagnosis and included clinically relevant predictors except CMV status and Karnofsky performance status. The risk conferred by age at the time of transplantation varies according to the number of HLA-mismatches and leads to a disproportional increase in risk for elderly patients, particularly with double mismatched donors. Our findings highlight the importance of HLA-matching, especially in patients over 55 years of age, as HLA-mismatches are less well tolerated in these patients. The interaction between age associated risk and HLA-mismatches should be considered in donor selection and in the risk assessment of elderly HSCT recipients.
- Received June 20, 2016.
- Accepted December 28, 2016.
- Copyright © 2017, Ferrata Storti Foundation