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<p>Comparative data on alternative donor platforms in adolescent and young adult (AYA) allogeneic hematopoietic cell transplantation (HCT) are limited. We conducted a nationwide retrospective registry study in Japan comparing unrelated umbilical cord blood transplantation (UCBT), haploidentical transplantation without post-transplant cyclophosphamide (non-PTCy-haplo), and PTCy-based haploidentical transplantation (PTCy-haplo). The study included 458 patients aged 16–25 years (UCBT, <i>n</i> = 101; non-PTCy-haplo, <i>n</i> = 132; PTCy-haplo, <i>n</i> = 225). The main endpoints were overall survival (OS) and relapse-free survival (RFS); relapse, non-relapse mortality (NRM), graft-versus-host disease (GVHD), and engraftment were also evaluated. UCBT showed the most favorable survival. In multivariable analyses, non-PTCy-haplo was associated with inferior OS and RFS, higher NRM, and a higher incidence of grade II–IV acute GVHD than UCBT. PTCy-haplo was associated with inferior OS versus UCBT but showed no significant differences in RFS, relapse, NRM, acute GVHD, or chronic GVHD. Both haploidentical platforms showed faster neutrophil engraftment than UCBT, and PTCy-haplo also showed faster platelet engraftment. Sensitivity analyses restricted to malignant disease and stratified by conditioning intensity supported these findings. In this AYA cohort, UCBT was associated with the most favorable survival, non-PTCy-haplo showed consistently inferior outcomes, and PTCy-haplo remained a practical alternative when rapid donor availability and early hematopoietic recovery are prioritized.</p>

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Comparative outcomes of umbilical cord blood transplantation versus haploidentical transplantation according to post-transplant cyclophosphamide use in adolescent and young adult patients

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Ryu Yanagisawa,
  • Itaru Kato,
  • Hiromi Hayashi,
  • Shin-Ichiro Fujiwara,
  • Noriko Doki,
  • Yuta Hasegawa,
  • Shinichi Kako,
  • Yasuhiko Shibasaki,
  • Satoshi Yoshihara,
  • Nobuhiro Hiramoto,
  • Takahiro Fukuda,
  • Naoyuki Uchida,
  • Hirohisa Nakamae,
  • Tetsuya Eto,
  • Koji Nagafuji,
  • Mamiko Sakata-Yanagimoto,
  • Masatsugu Tanaka,
  • Katsutsugu Umeda,
  • Yoshinobu Kanda,
  • Ken Tabuchi,
  • Yoshiko Atsuta,
  • Junya Kanda,
  • Hideki Nakasone

摘要

Comparative data on alternative donor platforms in adolescent and young adult (AYA) allogeneic hematopoietic cell transplantation (HCT) are limited. We conducted a nationwide retrospective registry study in Japan comparing unrelated umbilical cord blood transplantation (UCBT), haploidentical transplantation without post-transplant cyclophosphamide (non-PTCy-haplo), and PTCy-based haploidentical transplantation (PTCy-haplo). The study included 458 patients aged 16–25 years (UCBT, n = 101; non-PTCy-haplo, n = 132; PTCy-haplo, n = 225). The main endpoints were overall survival (OS) and relapse-free survival (RFS); relapse, non-relapse mortality (NRM), graft-versus-host disease (GVHD), and engraftment were also evaluated. UCBT showed the most favorable survival. In multivariable analyses, non-PTCy-haplo was associated with inferior OS and RFS, higher NRM, and a higher incidence of grade II–IV acute GVHD than UCBT. PTCy-haplo was associated with inferior OS versus UCBT but showed no significant differences in RFS, relapse, NRM, acute GVHD, or chronic GVHD. Both haploidentical platforms showed faster neutrophil engraftment than UCBT, and PTCy-haplo also showed faster platelet engraftment. Sensitivity analyses restricted to malignant disease and stratified by conditioning intensity supported these findings. In this AYA cohort, UCBT was associated with the most favorable survival, non-PTCy-haplo showed consistently inferior outcomes, and PTCy-haplo remained a practical alternative when rapid donor availability and early hematopoietic recovery are prioritized.