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Blood, 1 October 2001, Vol. 98, No. 7, pp. 2043-2051
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Donor characteristics as risk factors in recipients after
transplantation of bone marrow from unrelated donors: the effect of
donor age
Craig Kollman,
Craig W. S. Howe,
Claudio Anasetti,
Joseph H. Antin,
Stella M. Davies,
Alexandra H. Filipovich,
Janet Hegland,
Naynesh Kamani,
Nancy A. Kernan,
Roberta King,
Voravit Ratanatharathorn,
Daniel Weisdorf, and
Dennis L. Confer
From the National Marrow Donor Program and the
University of Minnesota, Minneapolis; Fred Hutchinson Cancer Research
Center, Seattle, WA; Brigham and Women's Hospital, Boston, MA;
Children's Hospital of Cincinnati, OH; Children's National Medical
Center, Washington, DC; Memorial Sloan- Kettering Cancer Center, New
York, NY; and the University of Michigan, Ann Arbor.
The National Marrow Donor Program (NMDP) maintains a registry of
approximately 4 million volunteer unrelated donors for patients in need
of a stem cell transplant. When several comparably HLA-matched volunteers are identified for a patient, various criteria are used to
select a donor. A retrospective analysis of 6978 bone marrow
transplantations facilitated by the NMDP from 1987 to 1999 was
conducted to study the effects of various donor characteristics on
recipient outcome. The evaluation addressed possible effects of donor
age, cytomegalovirus serologic status, ABO compatibility, race, sex,
and parity on overall and disease-free survival, acute and chronic
graft-versus-host disease (GVHD), engraftment, and relapse. Age was the
only donor trait significantly associated with overall and disease-free
survival. Five-year overall survival rates for recipients were 33%,
29%, and 25%, respectively, with donors aged 18 to 30 years, 31 to 45 years, and more than 45 years (P = .0002). A similar
effect was observed among HLA-mismatched cases (28%, 22%, and 19%,
respectively). A race mismatch between recipient and donor did not
affect outcome. The cumulative incidences of grade III or IV acute GVHD
were 30%, 34%, and 34%, respectively, with donors aged 18 to 30 years, 31 to 45 years, and more than 45 years (P = .005).
The corresponding incidences of chronic GVHD at 2 years were 44%,
48%, and 49% (P = 0.02). Recipients with female donors
who had undergone multiple pregnancies had a higher rate of chronic
GVHD than recipients with male donors (54% versus 44%;
P < .0001). The use of younger donors may lower the
incidence of GVHD and improve survival after bone marrow
transplantation. Age should be considered when selecting among
comparably HLA-matched volunteer donors.
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