Unrelated Donor Age and Recipient Outcomes After Posttransplant Cyclophosphamide vs Conventional Prophylaxis

Does older age in unrelated donors have the same adverse association with survival outcomes after allogeneic hematopoietic cell transplant (HCT) in patients receiving posttransplant cyclophosphamide (PTCy) vs calcineurin inhibitor (CNI)−based prophylaxis?In this cohort study of 10 025 HCT recipients, increasing donor age was associated with worse overall survival in those receiving CNI-based prophylaxis. This association was substantially attenuated and not statistically significant with PTCy-based prophylaxis, a finding supported by machine learning models.These findings indicate that the negative association of older donor age with HCT survival appears mitigated with PTCy, suggesting increased flexibility for selecting older unrelated donors when PTCy is used.

Corresponding Author: Rohtesh S. Mehta, MD, MPH, MS, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0423, Houston, TX 77030 (rmehta1@mdanderson.org).

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