Allogeneic hematopoietic cell transplantation (alloHCT) from 8/10 HLA-matched unrelated donor is performed in a minority of patients. There is little data on its outcomes and consequently, guidelines on optimal transplantation procedures are lacking. The Transplant complications working party of the EBMT performed a registry study comparing approaches to graft-versus-host disease (GVHD) prophylaxis in recipients of alloHCT from 8/10 HLA-mismatched unrelated donors (8/10 MMUD). The analysis included 450 adult patients with hematological malignancies receiving a first alloHCT between 2015 and 2021, GVHD prophylaxis strategies included ATG in 318 and PTCy in 132 patients. AlloHCT from 8/10 MMUD resulted in 21.1% non-relapse mortality, 28.5% cumulative incidence of relapse, 55.7% overall survival (OS), 50.4% progression-free-survival and 39.8% GVHD-relapse-free survival (GRFS). PTCy decreased the risk of grade II-IV (HR 0.63, 95%CI 0.40-0.99) and III-IV acute GVHD (HR 0.31, 95%CI 0.13-0.74), improved OS (HR 0.63, 95%CI 0.41-0.95) and GRFS (HR 0.65, 95%CI 0.47-0.91). No other differences between the groups were documented. Transplantation from female donors to male recipients increased the incidence of extensive chronic GVHD (HR 2.39, 95%CI 1.10-5.19) and decreased PFS (HR 1.49, 95%CI 1.01-2.20). AlloHCT from 8/10 HLA-matched unrelated donor is feasible and the use of PTCy in GVHD prophylaxis improves outcomes.

Comprehensive Cancer Center Faculty of Life Sciences and Medicine King's College London London UK

Department for Haematology Oncology and Tumorimmunology Medical Clinic Charité Universitätsmedizin Berlin Berlin Germany

Department of Hematology Rijeka University Hospital Centre Rijeka Croatia

Department of Hematology University Hospitals Leuven and Department of Public Health and Primary Care Academic Centre for Nursing and Midwifery KU Leuven Leuven Belgium

Essen University Hospital Essen Germany

Hannover Medical School Hannover Germany

Hematology Department Institut Catala d'Oncologia Hospital Duran i Reynals L'Hospitalet De Llobregat IDIBELL Universitat de Barcelona Barcelona Spain

Institute of Hematology and Blood Transfusion Prague Czech Republic

Ospedale Infantile Regina Margherita Torino Italy

Ospedale San Gerardo Monza Italy

Programme de Transplantation and Therapie Cellulaire Marseille France

RM Gorbacheva Research Institute Pavlov University St Petersburg Russia

S S C 5 D Trapianto di Cellule Staminali Torino Italy

Saint Louis Hospital BMT Unit Paris France

Tor Vergata University of Rome Rome Italy

Transplant Complications Working Party of EBMT Paris France

Universitaet Tuebingen Tuebingen Germany

University Hospital Eppendorf Hamburg Germany

University of Freiburg Freiburg Germany

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