Human leukocyte antigen (HLA)-matched sibling donors (MSDs) are the preferred choice for allogeneic hematopoietic cell transplantation (HCT). However, as myelodysplastic syndrome (MDS) is most frequently diagnosed in the elderly, MSDs are also likely to be of advanced age. It is unclear whether an MSD should be considered the primary choice for allogeneic HCT in elderly patients with MDS. We retrospectively compared survival and other outcomes in 1787 patients with MDS over 50 years of age and receiving allogeneic HCT between 2014 and 2020, using either MSD (n = 214), 8/8 allele-matched unrelated donor (MUD) (n = 562), 7/8 allele-MUD (n = 334), or unrelated cord blood (UCB) (n = 677) in Japan. In multivariate analysis, compared to MSD transplants, the risk of relapse was significantly lower following 8/8MUD transplants (hazard ratio [HR], 0.74; P = 0.047), whereas non-relapse mortality was significantly higher following UCB transplants (HR, 1.43; P = 0.041). However, donor type did not determine overall survival, disease-free survival, or graft-versus-host disease (GVHD)-free, relapse-free survival, but chronic GVHD-free, relapse-free survival was better after UCB (HR, 0.80; P = 0.025) and 8/8MUD (HR, 0.81; P = 0.032) compared to MSD transplants. Our study demonstrated that MSDs are not superior to alternative HCT methods, such as 8/8MUD, 7/8MUD, or UCB, in this population.

人类白细胞抗原（HLA）匹配的同胞供体（MSD）是同种异体造血细胞移植（HCT）的首选。然而，由于骨髓增生异常综合征 (MDS) 最常在老年人中诊断出来，因此 MSD 也可能是高龄患者。目前尚不清楚 MSD 是否应被视为老年 MDS 患者同种异体 HCT 的主要选择。我们回顾性比较了 2014 年至 2020 年间 1787 名 50 岁以上 MDS 患者接受同种异体 HCT 的生存率和其他结果，使用 MSD (n = 214)、8/8 等位基因匹配的无关供体 (MUD) ( n  = 562) ）、7/8 等位基因-MUD（n = 334）或 日本 无关脐带血（UCB）（n = 677）。在多变量分析中，与 MSD 移植相比，8/8MUD 移植后复发的风险显着较低（风险比 [HR]，0.74；P = 0.047），而 UCB 移植后的非复发死亡率显着较高（HR，1.43  ） ；P  = 0.041）。然而，供体类型并不能决定总生存期、无病生存期或无移植物抗宿主病 (GVHD)、无复发生存期，但 UCB 后无慢性 GVHD、无复发生存期更好（HR、 与 MSD 移植相比，HR 为 0.80；P  = 0.025）和 8/8MUD（HR，0.81；P = 0.032）。我们的研究表明，在该人群中，MSD 并不优于其他 HCT 方法，例如 8/8MUD、7/8MUD 或 UCB。