{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:15Z","timestamp":1787721615962,"version":"build-2784847793"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2021YFA1100904"],"award-info":[{"award-number":["2021YFA1100904"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82570261, 82270162, 82270224"],"award-info":[{"award-number":["82570261, 82270162, 82270224"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"\n Introduction<\/jats:title>\n With advancing safety profiles in allogeneic hematopoietic stem cell transplantation (allo-HSCT), determining whether HLA-matched siblings remain the optimal donor choice for older adults (\u226540 years) and whether haploidentical-HSCT demonstrates superior survival outcomes have become pivotal focuses in transplantation research.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The goal of this study was to explore the efficacy of haploidentical or matched sibling allo-HSCT in patients over the age of 40 years with acute leukemia (AL) and myelodysplastic syndrome (MDS), with a prespecified primary endpoint of GVHD-free, relapse-free survival (GRFS). In this retrospective study, 195 consecutive AL\/MDS patients (\u226540 years) who received allo-HSCT between December 2014 and December 2023 were included and analyzed using a 1:2 matched-pair design. All patients received antithymocyte globulin (ATG)-based GVHD prophylaxis. The cohort comprised 130 patients with haploidentical donors (HIDs) and 65 with HLA-matched sibling donors (MSDs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Patients who received transplants from offspring haploidentical donors with mismatched DRB1 exhibited a significantly lower 5-year cumulative incidence of relapse (15.4%) than those who received MSDs-HSCT (45.3%) or transplants from offspring haploidentical DRB1-matched donors (26.7%; p &lt; 0.001). However, the 5-year nonrelapse mortality (NRM) was highest in the offspring haploidentical B-leader-mismatched group (43.8%) compared with that in the B-leader-matched group (15.4%) and MSDs group (6.3%). Accordingly, in univariate analysis, recipients of offspring haploidentical B-leader-matched donors exhibited superior OS and DFS compared with recipients of older MSDs or offspring B-leader-mismatched donors; multivariate analysis further identified B-leader matching as an independent protective factor against NRM and an independent factor associated with improved GRFS.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In AL\/MDS patients aged \u226540 years, offspring haploidentical B-leader-matched donors were associated with favorable survival outcomes compared with older MSDs, primarily driven by reduced NRM; additionally, DRB1 mismatching was independently associated with reduced relapse.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1922699","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:42:20Z","timestamp":1787719340000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Superior outcomes with offspring B-leader-matched haploidentical versus older matched sibling donors in AL\/MDS patients aged \u226540 years"],"prefix":"10.3389","volume":"17","author":[{"given":"Yujun","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Hematology, the First Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]},{"name":"School of Medicine, Nankai University","place":["Tianjin, China"]},{"name":"State Key Laboratory of Experimental Hematology, Senior Department of Hematology, the Fifth Medical Center of PLA General Hospital","place":["Beijing, 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