Infographic: Optimizing Haploidentical Donor Selection for Pediatric Hematopoietic Cell Transplant

Infographic · May 2026 · 2 min read

In brief

Analysis of over 1,000 pediatric haploidentical transplants 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 the highest GVHD risk across all age groups, suggesting sibling donors should be prioritized when available.

Donors under 18 years old have significantly lower rates of acute and chronic GVHD compared to adult donors in pediatric haploidentical transplant.
Maternal donors carry 2-3× higher chronic GVHD risk versus paternal or sibling donors, independent of donor age.
Sibling haploidentical donors should be prioritized when available to minimize both acute and chronic GVHD in pediatric recipients.
Parental donors have higher acute GVHD rates than sibling donors, with mothers showing highest chronic GVHD risk across all age groups.
Donor age >35 years associated with 31% grade II-IV acute GVHD versus 15% in donors <18 years in pediatric haploidentical HCT.

Written by the GCMD Library team from the infographic.

The infographic uses a teal and yellow color scheme with icons including a calendar, blood cells, and illustrated figures of adults with children and sibling pairs. The layout is divided into sections with the study details at top, primary outcome in the middle, risk factors shown with contrasting red and green text, and conclusion at bottom. Illustrations visually distinguish higher-risk donors (parent with children) from lower-risk donors (sibling pairs).

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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