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Impact of donor selection in adverse-risk AML undergoing hematopoietic cell transplantation: A study from the EBMT Acute Leukemia Working Party

Bone Marrow Transplantation volume 61, pages 187–196 (2026)Cite this article

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Abstract

We evaluated the influence of donor type in 3006 adults with adverse-risk cytogenetic acute myeloid leukemia (AML) in first complete remission undergoing allogeneic hematopoietic cell transplantation (HCT). Donor types included matched sibling (MSD), matched unrelated (MUD), mismatched unrelated (MMUD), and haploidentical donors. At 2 years, leukemia-free survival, overall survival (OS), and graft-versus-host disease (GVHD)-free/relapse-free survival were 47%, 55%, and 36%. Compared with MSD, OS was inferior with MUD (HR 1.36; 95% CI, 1.1–1.67), MMUD (HR 1.4; 95% CI, 1.07–1.83), and haploidentical grafts (HR 1.33; 95% CI, 1.02–1.73). Haploidentical was associated with lower relapse risk (HR 0.72; 95% CI, 0.53–0.97), but higher non-relapse mortality (NRM) (HR 3.85; 95% CI, 2.44–6.08). All alternative donors showed higher rates of grade II–IV acute GVHD. In 702 patients receiving post-transplant cyclophosphamide (PTCy), survival differences attenuated. However, haploidentical and MMUD showed higher risk of grade III–IV acute GVHD (HR 2.61; 95% CI, 1.04–6.54 and HR 3.74; 95% CI, 1.14–12.24), and haploidentical had increased NRM (HR 3.22; 95% CI, 1.23–8.44), without significant relapse. Findings support safety of alternative donors and reinforce MSD as preferred choice in adverse-risk AML. PTCy mitigates but does not eliminate the risk of donor mismatch.

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Fig. 1: Cumulative incidence (CI) of graft-versus-host disease (GVHD) according to donor type.
Fig. 2: Cumulative incidence (CI) of main transplant outcomes according to donor type.
Fig. 3: Cumulative incidence (CI) of graft-versus-host disease (GVHD) according to donor type in the PTCy cohort.
Fig. 4: Cumulative incidence (CI) of main transplant outcomes according to donor type in the PTCy cohort.

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Data availability

The dataset supporting the conclusions of this article is available from the ALWP of the EBMT, Saint Antoine Hospital, Paris.

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Author information

Authors and Affiliations

  1. Hospital Universitari i Politècnic La Fe, Valencia, Spain

    Marta Villalba & Jaime Sanz

  2. EBMT Paris Office, Hospital Saint Antoine, Paris, France

    Allain-Thibeault Ferhat

  3. Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Tobias Gedde-Dahl

  4. Saint-Louis Hospital, BMT Unit, Paris, France

    Gerard Socie

  5. CHU - Institut Universitaire du Cancer Toulouse, Toulouse, France

    Anne Huynh

  6. Medizinische Klinik m. S. Hamatologie, Onkologie und Tumorimmunologie, Berlin, Germany

    Igor Wolfgang Blau

  7. CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France

    Ibrahim Yakoub-Agha

  8. Programme de Transplantation & Therapie Cellulaire, Marseille, France

    Didier Blaise

  9. Hannover Medical School, Hannover, Germany

    Matthias Eder

  10. CHU Bordeaux, Hopital Haut-Leveque, Pessac, France

    Edouard Forcade

  11. Azienda Ospedaliero Universitaria di Udine, Udine, Italy

    Renato Fanin

  12. University Hospital Basel, Basel, Switzerland

    Jakob Passweg

  13. Addenbrookes Hospital Cambridge, Cambridge, United Kingdom

    Charles Crawley

  14. University Hospital Münster, Münster, Germany

    Matthias Stelljes

  15. Division of Stem Cell Transplantation and Cellular Immunotherapy, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany

    Friedrich Stölzel

  16. University Hospital Eppendorf, Hamburg, Germany

    Nicolaus Kroeger

  17. Rigshospitalet, Copenhagen, Denmark

    Henrik Sengeloev

  18. CHU Lapeyronie, Montpellier, France

    Patrice Ceballos

  19. Centre Hospitalier Lyon Sud, Lyon, France

    Helene Labussiere-Wallet

  20. Cliniques Universitaires St. Luc, Brussels, Belgium

    Xavier Poiré

  21. Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

    Jordi Esteve

  22. Vanderbilt University Medical Center, Department of Hematology, Nashville, TN, USA

    Bipin Savani

  23. Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel

    Arnon Nagler

  24. Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Hematology, Vita-Salute San Raffaele University, Milan, Italy

    Simona Piemontese & Fabio Ciceri

  25. Hôpital Saint-Antoine, Sorbonne University, INSERM UMR 938, Paris, France

    Mohamad Mohty

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  1. Marta Villalba
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Contributions

M.V. and J.S. designed the study; A.F. performed statistical analysis and interpreted the results; M.V. and J.S. wrote the manuscript; A.F., T.G., G.S., A.H., I.W.B., I.Y., D.B., M.E., E.F., R.F., J.P., C.C., M.S., F.S., N.K., H.S., P.C., H.L., X.P., J.E., B.S., A.N., S.P., M.M., and F.C. provided patient data through the EBMT registry; and all authors reviewed and approved the manuscript.

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Correspondence to Marta Villalba.

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The scientific board of the ALWP of EBMT approved this study. All patients gave written informed consent for the use of their data.

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Villalba, M., Ferhat, AT., Gedde-Dahl, T. et al. Impact of donor selection in adverse-risk AML undergoing hematopoietic cell transplantation: A study from the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 61, 187–196 (2026). https://doi.org/10.1038/s41409-025-02751-7

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