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Grandparents are invaluable people as HLA-matched donors in hematopoietic stem cell transplantation
Background: HLA matching is one of the most important factors affecting patients' prognosis after hematopoietic stem cell transplantation (HSCT). Currently when there are no HLA-match siblings, transplantation centers try to find unrelated HLA-matched donor through bone marrow and cord blood registries. However, few studies showed that searching extended families such as parents , grandparents, aunts and uncles for an appropriate donor is useful.
Methods: This is a retrospective study from our center in which the patients who underwent HSCT of any diseases and their grandparents were as donors included in the study. The principal data including graft-versus-host-disease (GVHD) occurrence, overall survival (OS) and disease free survival (DFS) were used as main outcomes in these transplantations.
Results: Thirteen patients including 7 boys and 6 girls with mean age 5.33 years (range: 0.25-11) were detected through the data registry bank. The mean donors' age was 61.77 years (range: 45-75) and mean age difference was 56.44 years (range: 36.5-73) [table 1]. Regarding GVHD occurrence, 10 patients did experience acute GVHD [table 1]. With median follow-up of 16 months OS and DFS were 83% and 69% respectively.
Conclusion: Although searching the extended family for HLA-matched donors especially among grandparents seems very uncommon, this can increase the chance of well-tolerated and success transplantation especially in regions where consanguinity is common.
Table 1: Patients and donors characteristics
Patient number | Age (years) | Sex | Donor Age (years) | Donor Sex | Source of Progenitor | Age Difference(years) | Disease | Acute GVHD | Chronic GVHD | Patient Status | ||
1 | 6 | Male | 62 | Male | PB | 56 | ALL | Yes | No | Full chimerism/Alive | ||
2 | 5 | Male | 60 | Female | PB | 55 | TM II | Yes | No | Full chimerism/Alive | ||
3 | 2.5 | Female | 45 | Female | BM | 42.5 | LAD I | Yes | Yes | Full chimerism/Alive | ||
4 | 5.5 | Female | 63 | Male | PB | 57.5 | FA | Yes | No | Full chimerism/Alive | ||
5 | 7 | Male | 75 | Female | PB | 68 | TM II | Yes | No | Rejected/Dead | ||
6 | 2 | Female | 60 | Female | PB | 58 | AML | No | No | Rejected/ Alive | ||
7 | 11 | Male | 69 | Male | PB | 58 | FA | No | No | Full chimerism/Alive | ||
8 | 8.5 | Female | 68 | Male | PB | 59.5 | CD4 dif. | Yes | Yes | Full chimerism/Alive | ||
9 | 9.5 | Female | 46 | Female | BM | 36.5 | AML | Yes | No | Rejected/Dead | ||
10 | 2 | Male | 48 | Female | BM | 46 | MPS I | Yes | No | Full chimerism/Alive | ||
11 | 1 | Male | 74 | Male | PB | 73 | LAD I | Yes | Yes | Full chimerism/Alive | ||
12 | 9 | Male | 62 | Male | PB | 53 | TM III | No | No | Rejected/ Alive | ||
13 | 0.25 | Female | 71 | Male | PB | 70.75 | SCID | Yes | No | Full chimerism/Alive | ||
PB: Peripheral Blood, BM: Bone Marrow, ALL: Acute Lymphoblastic Leukemia, TM: Thalassemia Major, LAD: Leukocyte Adhesion Deficiency, FA: Fanconi Anemia, CD4 dif: CD4 deficiency, AML: Acute Myeloid Leukemia, MPS: Mucopolysaccharidoses, SCID: Severe Combined Immunodeficiency
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