• Yasuyuki Arai, Tadakazu Kondo, Hirohito Yamazaki, Katsuto Takenaka, Junichi Sugita, Takeshi Kobayashi, Yukiyasu Ozawa, Naoyuki Uchida, Koji Iwato, Naoki Kobayashi, Yoshiyuki Takahashi, Ken Ishiyama, Takahiro Fukuda, Tatsuo Ichinohe, Yoshiko Atsuta, Takehiko Mori, Takanori Teshima, and Japan Society for Hematopoietic Cell Transplantation.
• Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Tokyo, Japan.
• Haematologica. 2016 May 1; 101 (5): 644-52.

AbstractAllogeneic bone marrow transplantation is an essential therapy for acquired aplastic anemia and prognosis has recently improved. However, engraftment failure and graft-versus-host disease are potential fatal complications. Various risk factors for poor prognosis have been identified, such as patient age and human-leukocyte antigen disparity, but the relationship between donor age and prognosis is still unknown. Therefore, we performed a cohort study to compare the prognosis of unrelated bone marrow transplantation from younger and older donors using the registry database in Japan. We evaluated 427 patients (age 16-72 years) with aplastic anemia who underwent bone marrow transplantation from younger (≤39 years, n=281) or older (≥40 years, n=146) unrelated donors. Overall survival of the older donor group was significantly inferior to that of the younger donor group (adjusted hazard ratio 1.64; 95% confidence interval 1.15-2.35; P<0.01). The incidence of fatal infection was significantly higher in the older donor group (13.7% vs. 7.5%; P=0.03). Primary engraftment failure and acute graft-versus-host disease were significantly more frequent in the older donor group (9.7% vs. 5.0%; adjusted hazard ratio 1.30; P=0.01, and 27.1% vs. 19.7%; adjusted hazard ratio 1.56; P=0.03, respectively). Acute graft-versus-host disease was related to a worse prognosis in the whole cohort. This study showed the inferiority of older donors in aplastic anemia; thus, donor age should be considered when multiple donors are available. A large-scale prospective study is warranted to establish a better donor selection algorithm for bone marrow transplantation in aplastic anemia.Copyright© Ferrata Storti Foundation.

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