Transplant outcomes using older matched sibling donors compared with young alternative donors: a CIBMTR analysis
Bibliographic record
Abstract
ABSTRACT: Whether older HLA-matched sibling donors (MSD) are preferred over younger alternative donors for allogeneic hematopoietic cell transplantation (allo-HCT) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is unclear. We compared outcomes in allo-HCT recipients ≥50 years old after HCT from an older MSD (≥50 years) with recipients of younger (≤35 years) HLA-matched unrelated donor (MUD), haploidentical related donor (haplo), and HLA-mismatched unrelated donor (MMUD), grouped based on PTCy or calcineurin-inhibitor (CNI) based GVHD prophylaxis, that were reported to the Center for International Blood and Marrow Transplant Research between 2014 and 2021. The primary end point was overall survival (OS). Among 14 662 HCT recipients, 3746 received PTCy- and 10 916 CNI-based prophylaxis. In patients receiving PTCy-based HCT, the adjusted 5-year OS was similar between MSD and other donor types: 44% after MSD versus 52% after MUD (multivariable hazard ratio [HR]: 1.20; 95% confidence interval [CI], 1.03-1.41; P = .09), 45% after haplo donor (HR, 1.02; 95% CI, 0.88-1.18; P = 1.00), and 46% after MMUD (HR, 1.00; 95% CI, 0.83-1.21; P = 1.00). Compared with MSD, use of MUD associated with improved disease-free survival (DFS) with PTCy-based (HR, 1.21; 95% CI, 1.05-1.40; P = .048) and CNI-based (HR, 1.09; 95% CI, 1.04-1.15; P < .01) prophylaxis. Haplo donor use associated with worse OS compared with MUD use with PTCy (HR, 1.18; 95% CI, 1.05-1.33; P = .04). Older MSDs result in similar OS compared with younger alternative donors; however, use of a younger MUD associated with improved DFS in older-aged recipients.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".