DETERMINANTS OF PEDIATRIC HAPLOIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION (HCT) WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE (PT-CY): THE INFLUENCE OF DONOR CHARACTERISTICS
- 1Hospital do GRAACC, São Paulo, SP, Brazil
- 2Hospital do GRAACC, Vitória, ES, Brazil
Abstract
Introduction: Donor age and relationship has emerged as a key modifiable variable in haploidentical hematopoietic cell transplantation, with younger and sibling donors associated with reduced non-relapse mortality and graft-versus-host disease in adult cohorts. Evidence specific to pediatric patients using a uniform post-transplant cyclophosphamide platform, particularly from middle-income countries, remains scarce. Objectives: Evaluate the impact of donor age and donor relationship on acute and chronic graft-versus-host disease, graft failure, relapse, event-free survival, and overall survival in a post-transplant cyclophosphamide pediatric haploidentical transplant cohort. COHORT: 142 consecutive pediatric recipients of haploidentical hematopoietic cell transplantation, all receiving post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis at a single pediatric center in a high-middle-income country. Methods: Retrospective cohort study. Kaplan-Meier survival plots with log-rank test for group comparisons; cumulative incidence (CI) function for GVHD and graft failure. Multivariable Cox proportional hazards regression adjusted for donor relationship, donor age, cell source, patient sex, disease type (malignant vs. non-malignant), and donor lymphocyte infusion (DLI) for moderate-to-severe chronic GVHD. Primary cutoff: donor age ≤ 18 years (n = 31), 19-30 years (n = 70) and ≥ 31 years (n = 31); secondary cutoff: 1-10 years (n = 11), 11–18 years (n = 20), and > 18 gt; 18 years (n = 111). Results: No significant differences were found in overall survival (OS) (p = 0.86), event-free survival (EFS) (p = 0.47), relapse (p = 0.7), death (p = 0.9), or graft failure CI (p = 0.31) between donors in primary or secondary cutoff. MAGIC II-IV acute GVHD was significantly lower with sibling donors versus fathers, mothers, and Others (cousins and aunts) donors (23% vs. 43% vs. 45% vs. 62% at 1 year, p = 0,032). Moderate-to-severe chronic GVHD was significantly lower with Others vs. siblings, father and mother donors (0% vs. 19% vs. 22% vs. 51% at 1 year, p = 0,0059). Multivariate Cox Regression analysis revealed mother donors (HR 3.61, 95% CI 1.68–7.76, p = 0.001) and non-malignant disease (HR 0,24, 95% CI 0.08–0.75, p = 0.014) as significant predictors for moderate-to-severe chronic GVHD. Although not significant, we observed that donors 1-10 years had zero graft failures in 11 transplants vs. 3 failures in 20 transplants of the 11-18 years donor group (p = 0.054). Conclusions: In a pediatric haploidentical transplant cohort with uniform post-transplant cyclophosphamide, donor relationship was determinant for acute GVHD and chronic GVHD CI; mother donors were independently associated with augmented chronic GVHD, and non-malignant disease was independently associated with reduced chronic GVHD. There was no improvement nor decline in OS or EFS. Our results provide platform-specific pediatric evidence to guide donor selection where PTCY is standard of care.
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- CLOSING THE DONOR GAP: HAPLOIDENTICAL VS. HLA-MATCHED TRANSPLANTATION FOR SICKLE CELL DISEASE: DATA FROM THE BRAZILIAN REGISTRY OF HEMATOPOIETIC STEM CELL TRANSPLANTATION IN SICKLE CELL DISEASE, ON BEHALF OF THE SBTMO
BibTeX
@article{silva2026determinants,
title = {{DETERMINANTS OF PEDIATRIC HAPLOIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION (HCT) WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE (PT-CY): THE INFLUENCE OF DONOR CHARACTERISTICS}},
author = {Luiza Dornelles Penteado PACHECO E SILVA and Ana Carolina Ribeiro CORREA and Aline Ferrari MARTINS and Ana Cláudia Ramos Donatelli BRONZONI and Laís Lima QUINTINO and Maria Gabriela Alves Dias MATOS and Luciana Dos Santos DOMINGUES and Valéria Cortez GINANI and Roseane Vasconcelos GOUVEIA and Raisa Machado AMARAL and Fernanda De Oliveira MOTA and Lahis Cardoso de CASTRO and Maria De Los Angeles Duran SALAS and Lucas Augusto Monetta da SILVA and Beatriz Vale FARKAS and Yohanna Bastani de MATTOS and Mayara Satsuki KUNII and Adriane Da Silva Santos IBANEZ and Cintia Monteiro LUSTOSA and Camilla Margarida Maria Soares de Sousa PARRODE and Vanessa Aparecida do Nascimento VARJAO and Olga Margareth Wanderley de Oliveira FéLIX and Cristiane Menezes Vitoria ALFERI and Adriana SEBER},
journal = {Hematology, Transfusion and Cell Therapy},
year = {2026},
month = oct,
doi = {10.1016/j.htct.2026.106853},
url = {https://doi.org/10.1016/j.htct.2026.106853},
note = {CC BY},
}
RIS
TY - JOUR
TI - DETERMINANTS OF PEDIATRIC HAPLOIDENTICAL HEMATOPOIETIC CELL TRANSPLANTATION (HCT) WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE (PT-CY): THE INFLUENCE OF DONOR CHARACTERISTICS
AU - Luiza Dornelles Penteado PACHECO E SILVA
AU - Ana Carolina Ribeiro CORREA
AU - Aline Ferrari MARTINS
AU - Ana Cláudia Ramos Donatelli BRONZONI
AU - Laís Lima QUINTINO
AU - Maria Gabriela Alves Dias MATOS
AU - Luciana Dos Santos DOMINGUES
AU - Valéria Cortez GINANI
AU - Roseane Vasconcelos GOUVEIA
AU - Raisa Machado AMARAL
AU - Fernanda De Oliveira MOTA
AU - Lahis Cardoso de CASTRO
AU - Maria De Los Angeles Duran SALAS
AU - Lucas Augusto Monetta da SILVA
AU - Beatriz Vale FARKAS
AU - Yohanna Bastani de MATTOS
AU - Mayara Satsuki KUNII
AU - Adriane Da Silva Santos IBANEZ
AU - Cintia Monteiro LUSTOSA
AU - Camilla Margarida Maria Soares de Sousa PARRODE
AU - Vanessa Aparecida do Nascimento VARJAO
AU - Olga Margareth Wanderley de Oliveira FéLIX
AU - Cristiane Menezes Vitoria ALFERI
AU - Adriana SEBER
PY - 2026
DA - 2026/10/23
JO - Hematology, Transfusion and Cell Therapy
DO - 10.1016/j.htct.2026.106853
UR - https://doi.org/10.1016/j.htct.2026.106853
AB - Introduction: Donor age and relationship has emerged as a key modifiable variable in haploidentical hematopoietic cell transplantation, with younger and sibling donors associated with reduced non-relapse mortality and graft-versus-host disease in adult cohorts. Evidence specific to pediatric patients using a uniform post-transplant cyclophosphamide platform, particularly from middle-income countries, remains scarce. Objectives: Evaluate the impact of donor age and donor relationship on acute and chronic graft-versus-host disease, graft failure, relapse, event-free survival, and overall survival in a post-transplant cyclophosphamide pediatric haploidentical transplant cohort. COHORT: 142 consecutive pediatric recipients of haploidentical hematopoietic cell transplantation, all receiving post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis at a single pediatric center in a high-middle-income country. Methods: Retrospective cohort study. Kaplan-Meier survival plots with log-rank test for group comparisons; cumulative incidence (CI) function for GVHD and graft failure. Multivariable Cox proportional hazards regression adjusted for donor relationship, donor age, cell source, patient sex, disease type (malignant vs. non-malignant), and donor lymphocyte infusion (DLI) for moderate-to-severe chronic GVHD. Primary cutoff: donor age ≤ 18 years (n = 31), 19-30 years (n = 70) and ≥ 31 years (n = 31); secondary cutoff: 1-10 years (n = 11), 11–18 years (n = 20), and > 18 gt; 18 years (n = 111). Results: No significant differences were found in overall survival (OS) (p = 0.86), event-free survival (EFS) (p = 0.47), relapse (p = 0.7), death (p = 0.9), or graft failure CI (p = 0.31) between donors in primary or secondary cutoff. MAGIC II-IV acute GVHD was significantly lower with sibling donors versus fathers, mothers, and Others (cousins and aunts) donors (23% vs. 43% vs. 45% vs. 62% at 1 year, p = 0,032). Moderate-to-severe chronic GVHD was significantly lower with Others vs. siblings, father and mother donors (0% vs. 19% vs. 22% vs. 51% at 1 year, p = 0,0059). Multivariate Cox Regression analysis revealed mother donors (HR 3.61, 95% CI 1.68–7.76, p = 0.001) and non-malignant disease (HR 0,24, 95% CI 0.08–0.75, p = 0.014) as significant predictors for moderate-to-severe chronic GVHD. Although not significant, we observed that donors 1-10 years had zero graft failures in 11 transplants vs. 3 failures in 20 transplants of the 11-18 years donor group (p = 0.054). Conclusions: In a pediatric haploidentical transplant cohort with uniform post-transplant cyclophosphamide, donor relationship was determinant for acute GVHD and chronic GVHD CI; mother donors were independently associated with augmented chronic GVHD, and non-malignant disease was independently associated with reduced chronic GVHD. There was no improvement nor decline in OS or EFS. Our results provide platform-specific pediatric evidence to guide donor selection where PTCY is standard of care.
SN - 2531-1379
SN - 2531-1387
ER -