优选供体对成功的异基因造血干细胞移植（HCT）至关重要，供体年龄影响匹配无关供体（MUD）和半相合供体HCT后的生存率。尽管最近的研究显示MUD和半相合HCT之间有类似的结果，但目前不清楚与年龄较大的MUD进行的HCT相比，年轻半相合供体进行的HCT是否有差异。因此，我们进行了回顾性分析，比较了接受年轻（≤35岁）半相合供体（n = 494）或年长（> 35岁）MUD（n = 1005）的骨髓增生异常综合征（MDS）和急性髓系白血病（AML）患者的结果。半相合组和MUD组的患者分别接受移植后环磷酰胺（PTCy）和常规移植物抗宿主病（GVHD）预防。在多元分析中，使用年轻半相合供体与改善总生存率（风险比[HR]0.81、95%置信区间[CI]0.69-0.95，p = .01）和较低的Ⅱ-Ⅳ级急性GVHD发生率（HR 0.64、95% CI 0.53-0.77，p <.001）、Ⅲ-Ⅳ级急性GVHD发生率（HR 0.37、95% CI 0.25-0.53，p <.001）和慢性GVHD（HR 0.49、95% CI 0.40-0.60，p <.001）相关联。虽然接受骨髓抑制剂治疗的患者复发率相似，但接受弱化治疗的年轻半相合组患者的复发率更高（HR 1.49，95% CI 1.18-1.88，p = .001）。年轻半相合组术后3个月及以上的非复发性死亡率明显低于MUD组（HR 0.59、95% CI 0.38-0.90，p = .02）。我们的数据支持在MDS或AML患者中使用PTCy的年轻半相合供体而不是常规预防措施的年长MUD。有关半相合和MUD HCT使用PTCy预防措施中供体年龄的重要性的进一步研究是必要的。 © 2023 Wiley Periodicals LLC。

Optimal donor selection is fundamental to successful allogeneic hematopoietic cell transplantation (HCT), and donor age influences survival after both matched unrelated donor (MUD) and haploidentical donor HCT. Though recent studies have shown similar outcomes between MUD and haploidentical HCT, it is unknown if outcomes differ following HCT with younger haploidentical donors compared to HCT with older MUDs. Therefore, we performed a retrospective analysis comparing outcomes of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients who underwent HCT with younger (≤35 years) haploidentical donors (n = 494) or older (>35 years) MUDs (n = 1005). Patients in the haploidentical and MUD groups received post-transplant cyclophosphamide (PTCy) and conventional graft-versus-host-disease (GVHD) prophylaxis, respectively. In multivariate analysis, use of younger haploidentical donors was associated with improved overall survival (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69-0.95, p = .01) and lower rates of grade II-IV acute GVHD (HR 0.64, 95% CI 0.53-0.77, p < .001), grade III-IV acute GVHD (HR 0.37, 95% CI 0.25-0.53, p < .001), and chronic GVHD (HR 0.49, 95% CI 0.40-0.60, p < .001). Relapse rates were similar among those who received myeloablative conditioning but were higher in patients of the younger haploidentical group who received reduced intensity conditioning (HR 1.49, 95%CI 1.18-1.88, p = .001). The younger haploidentical group had significantly lower non-relapse mortality ≥3 months post-HCT (HR 0.59, 95% CI 0.38-0.90, p = .02). Our data support the use of younger haploidentical donors with PTCy over older MUDs with conventional prophylaxis in patients with MDS or AML. Further studies on the importance of donor age in haploidentical and MUD HCT with PTCy prophylaxis are warranted.© 2023 Wiley Periodicals LLC.