ArticleFrontiers in immunology2026
Donor-recipient age difference, not donor age alone, predicts outcomes in allogeneic hematopoietic stem cell transplantation for aplastic anemia.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The impact of donor age on outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for aplastic anemia (AA) remains poorly defined. The prognostic value of donor-recipient age difference (DRAD) has rarely been explored. Objective: To delineate the optimal donor age window and investigate the prognostic significance of the DRAD in AA patients undergoing allo-HSCT. Methods: This retrospective study included 261 AA patients who received first allo-HSCT between 2018 and 2025. Patients were stratified into four groups based on donor age quartiles (G1: <20 yrs; G2: 20-29 yrs; G3: 29-38 yrs; G4: >38 yrs) and also by DRAD (DRAD1: <-10yrs; DRAD2: -10 to 10yrs; DRAD3: >+10 yrs). Primary endpoints were overall survival (OS), failure-free survival (FFS), and GVHD-free, relapse-free survival (GRFS). Results: Donor age stratification alone did not significantly affect overall transplant outcomes. However, pairwise comparison showed that the G4 had significantly better OS than the G1 (5-year OS: 88.9% vs. 75.8%; Conclusion: Donor age alone did not independently predict outcomes, whereas DRAD is a more impactful clinical parameter. A much younger donor (DRAD1) predicts poor outcomes, while age-matched donor-recipient pairing (DRAD2) offers the best balance of efficacy and safety. These findings raise the hypothesis that donor-recipient age matching may be preferable to simply pursuing the youngest donor. However, given the single-center nature of this study, external validation in independent cohorts is warranted before routine adoption in clinical practice.
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