PURPOSE Critical guidance on selecting haploidentical donors for pediatric patients is lacking. It is unclear whether parents, siblings, and extended family affect acute and chronic graft-versus-host disease (aGVHD and cGVHD) differently. METHODS We analyzed 1,069 pediatric (35 years) and donor relationship, with multivariable analysis. RESULTS Donor age: Increased grade II-IV aGVHD occurred with older donors: >35 years (31%, odds ratio OR, 1.7 95% CI, 1.0 to 2.8; P = .05) and 18-35 years (23%, OR, 2.5 95% CI, 1.5 to 4.2; P = .0003), versus 35 years (incidence 30% 95% CI, 28 to 32; hazard ratio HR, 2.2 95% CI, 1.3 to 3.9; P = .004) and 18-35 years (incidence 26% 95% CI, 23 to 29; HR, 2.1 95% CI, 1.3 to 3.5; P = .0028) compared with 35 years, HR, 2.53 95% CI, 1.46 to 4.41; mothers 18-35 years, HR, 2.05 95% CI, 1.14 to 3.69) (cGVHD: mothers >35 years, HR, 3.10 95% CI, 1.72 to 5.60; mothers 18-35 years, HR, 3.35 95% CI, 1.8 to 6.25). CONCLUSION Donors <18 years are associated with reduced aGVHD and cGVHD, whereas maternal donors are associated with increased cGVHD risk. For pediatric patients, sibling donors should be considered to reduce GVHD.
Liberio et al. (Wed,) studied this question.