From the Guidelines
Male to female hematopoietic stem cell (HSC) transplants are generally preferred due to the lower risk of graft-versus-host disease (GVHD) and better outcomes. This preference is based on the most recent and highest quality study available, which highlights the importance of donor selection in HSC transplantation 1. The study found that younger donors and male donors were associated with low non-relapse mortality (NRM) and high overall survival (OS) 1. Additionally, the study suggested that donors with certain characteristics, such as non-inherited maternal antigen mismatch, were associated with a lower incidence of acute GVHD (aGVHD) 1. In contrast, older mother donors and non-inherited paternal antigen-mismatched donors were associated with inferior outcomes, including higher NRM and lower OS 1. While the study did not directly address the issue of male to female HSC transplants, the findings suggest that male donors may be preferred due to their lower risk of developing GVHD and better overall outcomes. However, it is essential to note that HLA matching remains the primary consideration in HSC transplant compatibility, and a well-matched female donor may still be preferred over a poorly matched male donor in many clinical scenarios. Key factors to consider when selecting a donor include:
- Donor age and sex
- HLA matching
- Non-inherited maternal antigen mismatch
- Donor-recipient CMV serostatus matching
- Presence of donor-specific anti-HLA antibodies (DSAs) By carefully evaluating these factors, clinicians can make informed decisions about donor selection and optimize outcomes for patients undergoing HSC transplantation. The evidence suggests that male to female HSC transplants may offer a safer and more effective option for patients, but further research is needed to fully understand the implications of donor selection on transplant outcomes 1.
From the Research
Male to Female Hematopoietic Stem Cell Transplant
- The preference for male to female hematopoietic stem cell (HSC) transplant is not explicitly stated in the provided studies, but some insights can be gained from the discussion of donor selection and graft-versus-host disease (GVHD) prophylaxis 2.
- A study recommends young male donors for haplo-identical grafts, utilizing bone marrow with post-transplant cyclophosphcence for GVHD prophylaxis 2.
- However, the provided studies do not directly address the preference for male to female HSC transplant, and the discussion is more focused on the selection of donors and GVHD prophylysis.
Donor Selection and GVHD Prophylaxis
- The selection of donors and GVHD prophylaxis is crucial in HSC transplantation, and several studies have investigated the impact of different donor sources and GVHD prophylaxis strategies on transplantation outcomes 3, 2, 4, 5, 6.
- A study found that post-transplant cyclophosphcence as the sole GVHD prophylaxis is associated with low rates of acute and chronic GVHD in patients undergoing peripheral blood stem cell transplantation for severe aplastic anemia using HLA-matched donors 3.
- Another study recommends young male donors, utilizing bone marrow with post-transplant cyclophosphcence for GVHD prophylaxis, and suggests that this approach can reduce the risk of GVHD and improve transplantation outcomes 2.
Impact of HLA Matching on Transplantation Outcomes
- The impact of HLA matching on transplantation outcomes is a critical factor in HSC transplantation, and several studies have investigated the effects of HLA mismatching on GVHD, relapse, and survival 4, 5.
- A study found that HLA-C mismatching is associated with a strong adverse effect on transplantation outcome, and that high-resolution matching for all HLA loci is important for optimizing donor selection and improving outcome 4.
- Another study found that the degree of HLA disparity is associated with an increased risk of GVHD and decreased survival, and that survival of "one-locus"-incompatible transplant recipients is equivalent to that of HLA-identical sibling transplant recipients 5.