Myelodysplastic syndromes (MDS) are the second common indication for an Allo-HCT. We compared the outcomes of 1414 matched sibling (MSD) with 415 haplo-identical donors (HD) transplanted with post-transplant cyclophosphamide (PTCy) as GVHD prophylaxis between 2014 and 2017. The median age at transplant with MSD was 58 and 61 years for HD. The median time to neutrophil engraftment was longer for HD being 20 vs 16 days for MSD (p < 0.001). Two-year overall survival (OS) and PFS (progression free survival) with MSD were significantly better at 58% compared with 50%, p ≤ 0.001, and 51% vs 47%, p = 0.029, with a HD. Relapse at 2 years was lower with a HD 23% than with MSD 29% (p = 0.016). Non relapse mortality (NRM) was higher with HD in the first 6 months post-transplant [HR 2.59 (1.5–4.48) p < 0.001] and was also higher at 2 years being 30% for HD and 20% for MSD, p ≤ 0.001. The incidence of acute GVHD grade II-IV and III–IV at 100 days was comparable for MSD and HD, however, chronic GVHD at 2 years was significantly higher with MSD being 44% vs 32% for HD (p < 0.001). After multivariable analysis, OS and primary graft failure were significantly worse for HD particularly before 6 months [HR 1.93(1.24–3.0)], and HR [3.5(1.5–8.1)]. The median age of HD 37 (IQR 30–47) years was significantly lower than sibling donors 56 (IQR 49–62 years) p < 0.001. However, there was no effect on NRM, relapse or PFS. This data set suggests that a MSD donor remains the preferred choice in MDS over a haplo donor. Transplants with haploidentical donors result in satisfactory long-term outcome, justifying it’s use when no better donor is available.
骨髓增生异常综合征（MDS）是异基因造血干细胞移植的第二常见适应症。我们比较了2014年至2017年间接受移植后环磷酰胺（PTCy）作为移植物抗宿主病预防的1414例同胞全相合供者（MSD）与415例单倍体相合供者（HD）的移植结果。MSD移植中位年龄为58岁，HD为61岁。HD的中性粒细胞植入中位时间较长，为20天，而MSD为16天（p<0.001）。MSD的两年总生存率（OS）和无进展生存率（PFS）显著更优，分别为58%对50%（p≤0.001）和51%对47%（p=0.029）。HD的两年复发率较低，为23%，而MSD为29%（p=0.016）。HD在移植后前6个月的非复发死亡率（NRM）较高[风险比2.59（1.5-4.48），p<0.001]，两年NRM也较高（HD为30%，MSD为20%，p≤0.001）。MSD与HD在100天时的II-IV级和III-IV级急性移植物抗宿主病发生率相当，但MSD的两年慢性移植物抗宿主病发生率显著更高（44%对32%，p<0.001）。多变量分析后显示，HD的OS和原发性移植物失败显著更差，尤其在6个月前[OS风险比1.93（1.24-3.0），移植物失败风险比3.5（1.5-8.1）]。HD供者中位年龄为37岁（四分位距30-47岁），显著低于同胞供者的56岁（四分位距49-62岁）（p<0.001），但这并未对NRM、复发或PFS产生影响。该数据集表明，对于MDS患者，MSD供者仍是优于单倍体相合供者的选择。单倍体相合供者移植可获得满意的长期结果，在无更优供者时其使用是合理的。
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