Infographic: Optimizing Haploidentical Donor Selection for Pediatric Hematopoietic Cell Transplant

Infographic · May 2026 · 2 min read

In brief

Analysis of 1,069 pediatric haploidentical transplant cases reveals that younger donors (<18 years) and sibling donors are associated with significantly lower rates of acute and chronic GVHD compared to adult or parental donors. Maternal donors showed highest GVHD risk across all age groups.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing different surgical techniques, accompanied by statistical data boxes and outcome metrics. The design uses a clean, clinical color palette with icons and percentage indicators.

Nicole Liberio, Mariam Allbee-Johnson, Kwang Woo Ahn, Amy Moskop, Rachel Phelan, Bronwen E. Shaw, Kristin M. Page, Larisa Broglie

Purpose

Critical guidance on selecting haploidentical donors for pediatric patients is lacking. It is unclear whether parents, siblings, and extended family affect acute and chronic graft-versus-host disease (aGVHD and cGVHD) differently.

Methods

We analyzed 1,069 pediatric (<19 years) recipients of hematopoietic cell transplant during 2013-2019. Primary end points were aGVHD frequency at 100 days and cumulative incidence of cGVHD at 2 years, assessed by donor age (<18 years, 18-35, >35 years) and donor relationship, with multivariable analysis.

Results

Donor age: Increased grade II-IV aGVHD occurred with older donors: >35 years (31%, odds ratio [OR], 1.7 [95% CI, 1.0 to 2.8]; P = .05) and 18-35 years (23%, OR, 2.5 [95% CI, 1.5 to 4.2]; P = .0003), versus < 18 years (15%, reference OR, 1). Increased cGVHD occurred in older donors: >35 years (incidence 30% [95% CI, 28 to 32]; hazard ratio [HR], 2.2 [95% CI, 1.3 to 3.9]; P = .004) and 18-35 years (incidence 26% [95% CI, 23 to 29]; HR, 2.1 [95% CI, 1.3 to 3.5]; P = .0028) compared with <18 years (incidence 16% [95% CI, 12 to 20]; reference HR, 1). Donor relationship: Patients with parental donors had higher aGVHD risk than siblings (mother: OR, 1.9 [95% CI, 1.3 to 2.8]; P = .001; father: OR, 1.7 [95% CI, 1.1 to 2.5]; P = .009). Patients with maternal donors had a significantly higher risk of cGVHD than paternal (HR, 2.3 [95% CI, 1.6 to 3.3]; P < .0001) and sibling donors (HR, 2.3 [95% CI, 1.7 to 3.4]; P < .0001). Age-relationship interaction: Maternal donors were associated with more GVHD than siblings, regardless of age (aGVHD II-IV, mothers >35 years, HR, 2.53 [95% CI, 1.46 to 4.41]; mothers 18-35 years, HR, 2.05 [95% CI, 1.14 to 3.69]) (cGVHD: mothers >35 years, HR, 3.10 [95% CI, 1.72 to 5.60]; mothers 18-35 years, HR, 3.35 [95% CI, 1.8 to 6.25]).

Conclusion

Donors <18 years are associated with reduced aGVHD and cGVHD, whereas maternal donors are associated with increased cGVHD risk. For pediatric patients, sibling donors should be considered to reduce GVHD.

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