Haploidentical Young Donor Versus Fully Matched Elderly Donor for Patients Aged 50 Years or Older

Introduction Currently the ideal stem cell donor is a fully matched HLA sibling; nonetheless, an elderly patient has a high probability of an also aging donor. Age has been related to worse transplant outcomes, mainly due to the higher incidence of acute and chronic GVHD and higher mortality rates when compared to patients performing transplantation with younger donors, in addition to possible comorbidities that may make them ineligible for donation. Objectives Considering the excellent results of transplants with haploidentical donors, which are comparable to those obtained with fully matched donors, the present study aims at assessing which would be the best donor for the patient witch has a fully matched sibling of 50 years of age and older and a younger haploidentical child. Methods This is a consecutive retrospective descriptive observational epidemiological study involving all patients who underwent hematopoietic progenitor cell transplantation with a fully matched or partially matched (haploidentical) related donor during the period from January 2010 to October 2017. Overall survival of patients aged 50 years or older was the primary outcome of the study. Results An amount of 47 patients was included in the study. In 72% the diagnosis was acute myelogenous leukemia or myelodysplastic syndrome.Regarding the compatibility, in 31 (65.9%) of the procedures the donor was fully matched and in 16 (34.1%) the donor was haploidentical. The mean age of the patients was 63 years in both groups, but the mean age of donors was significantly higher among the fully matched donors, who were on average 60 years with a range between 32 and 82. All of these donors were siblings of the receptor. About the haploidentical donors, the mean age was 37 years, ranging from 21 to 66 years, and 87% were children of the recipient. We did not observe a statistically significant difference in overall survival between patients whose donor was fully matched or haploidentical. The age of the donor ( The time of hospitalization of patients submitted to haploidentical transplantation was greater than that patients whose donor was fully matched (69.6 days and 36.7 days respectively, p = 0.001). Conclusion The results obtained in the study demonstrate the non-inferiority of the donor haploidentico in relation to the fully matched donor for patients aged 50 years or more.