Donor-Patient Age and Gender as Influential Factors for Graft Versus Host Disease Incidence and Survival After AllogeneicHematopoietic Stem Cell Transplantation

Background and Aim: Allogeneic hematopoietic stem-cell transplantation(allo-HSCT) has become routine for the treatment of many hematologicalmalignancies, while graft-versus-host Disease (GvHD) is still an inevitableundesirable and serious consequence. A Variety of donor and patientfactors including donor-recipient HLA matching, ABO compatibility,race, and cytomegalovirus serologic state can affect the GvHD incidenceand survival. In this study, we examined the effect of donor-patientgender and age on GvHD incidence and survival in patients underwentallo-HSCT in Taleghani bone marrow transplantation center.Methods: This study was carried on 196 leukemic patients who receivedallo-HSCT between 2008 and 2017 in the bone marrow transplantationcenter of Taleghani hospital, Tehran. 34.5% were male recipients withfemale donors, 30% male recipients with male donors, 15.5% femalerecipients with female donors, and 20% female recipients with maledonors. Factor analyzed were donor-patient gender and age, andaccordingly, patient survival was calculated by using the Kaplan–Meiermethod. The GvHD incidence was estimated using the cumulativeincidence curves and proportional sub-distribution hazard regressionmodel.Results: The main findings were that HSCT with female donors resultedin significantly higher rate of GVHD (57% versus 52% , P value ≤0.0001)and lower survival (50% versus 60%, P value = 0.001) compared toHSCT with male donors. In addition, male recipients with female donors showed an increase in the risk of GvHD incidence. (HR,1.16, 95%CI,1.04-1.25, P=0.006). younger donors (aged less than 30 years) wereassociated with better survival (48% versus 40%, P value = 0.009) and alower rate of GvHD ( 53% versus 62%, P value = 0.04). therefore, olderpatient and older donor regardless of donor sex were associated with ahigher rate of GvHD (P-value= 0.003 and P-value= 0.03 respectively).Conclusion: Donor and patient characteristics such as age and genderhave been demonstrated to influence the allo-HSCT outcome includingGvHD incidence and survival. Overall, recipients of grafts from femaledonors had a significantly higher rate of GvHD and worst survival thanrecipients with male donors. Moreover, younger donors may result ina lower rate of GvHD and survival improvement after transplantation.Therefore, donor-patient age and sex are important risk factors forpredicting the allo-HSCT outcome.