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Following an allogenic hematopoietic stem cell transplantation (allo-HSCT) women had increased survival rates compared with men. These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Researchers from Duke University Medical Center performed a single center retrospective analysis of data from the Adult Blood and Marrow Transplant database. Patients (N=247) who received a first allo-HSCT between 1995 and 2014 were assessed for long-term survival (³5 years).
At baseline, patients were aged median 46 years (interquartile range [IQR], 38 to 54), 55.1% were men, and 51.8% allograft donors were men. At a follow-up of median 8 years (IQR, 6 to 10), 52.2% had developed chronic graft-versus-host disease, 65.6% had a complete response to their transplant, and 42 patients had died.
A significantly higher proportion of men (76.2%) died compared with women (P =.003). The survivorship among women was 0.99 (95% CI, 0.97-1) at 6 years and 0.62 (95% CI, 0.38-1) at 15 years. The survivorship among men was lower at both 6 (0.93; 95% CI, 0.93-0.99) and 15 (0.58; 95% CI, 0.46-0.74) years. Men had increased mortality risk after transplant (hazard ratio [HR], 3.106; 95% CI, 1.471-6.561; P =.003).
Stratified by donor gender, compared with men who received allographs from men, women who received allographs from women were at decreased risk for death (HR, 0.121; 95% CI, 0.028-0.527; P =.005). Neither women who received tissue from men (P =.435) nor men who received allographs from women (P =.094) had significantly different mortality risk.
Stratified by age and gender, women who were younger (<50 years) at the time of transplant had a lower rate of survival (0.42; 95% CI, 0.1-1) compared with older women (0.59; 95% CI, 0.32-1) at 15 years. The opposite pattern was observed among men (0.65; 95% CI, 0.51-0.82 vs 0.42; 95% CI, 0.1-1).
Graft-versus-host disease (HR, 2.303; 95% CI, 1.168-4.539; P =.016) and age at transplant (HR, 1.04; 95% CI, 1.008-1.073; P =.014) were significantly associated with mortality risk.
This study may have been limited by its strict inclusion criteria, which reduced their sample size from 1103 patients who received allo-HSCT at their center during the study period to 247.
These results, that men were at increased risk for mortality after receiving an allo-HSCT, were consistent with data from solid organ transplants, suggesting some gender-specific biological basis of poor long-term survival after transplant.
“Ultimately, we are left with several hypotheses, but no clear consensus as to why men have poor survival after allo-HCT. Most likely, this observation stems from a confluence of factors, possibly from an innate biological property of the male sex, greater allo-immune tolerance among females, as we see during pregnancy. Gender remains only one of many important prognostic factors that need to be considered when evaluating a patient for allo-[HSCT]” concluded Prioty Islam, MD, coauthor of the study.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Islam P, Jin H, Cao F, et al. Female gender is associated with improved long-term survival following allogeneic hematopoietic stem cell transplant. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 74.