ABSTRACT
Hematopoietic cell transplantation [HCT] is well established as therapy for hematologic malignancies as well as many non-malignant disorders. Donor selection is an important way to decrease the risks after HSCS and is therefore a key component of the clinical practice of transplantation. There are many criteria proved or hypothesized to affect outcomes after SCT and one of these, sex is the most controversial. Some investigators have found an increased risk of acute or chronic graft-versus-host disease [GVHD] associated with donor sex. Transplantation of stem cells from a female donor to a male recipient is a special circumstance in which donor T cells specific for minor H antigens, encoded by genes on the recipient Y-chromosome that are polymorphic to their X-chromosome homologues, may make a contribution to GVHD and GVL activity. Investigate the effect of donor and recipient sex mismatch on outcomes of HLA-identical sibling allogeneic stem cell transplantation. This study was carried on 82 patients selected from patients who had underwent a myelo-ablative preparative regimen for a hematologic malignancy and received HSC transplant from an HLA-identical sibling being divided into 2 groups: 1st one with a female donor to a male recipient and 2nd one include otherwise. Both groups will be subjected to HLA tissue typing, CBC, Bone marrow aspirate evaluation, PT and PTT, blood culture when needed, SGPT, SGOT, ALP, blood urea, s.creatinine, urine analysis, pulmonary function tests, chest x-ray, echocardiography ECG, CMV-, EBV-, VZV-, Toxoplasma- antibodies [IgG, IgM], HBs-Ag, HBs-Ab, and HCV-Ab. After variables controlling for patient and donor, there was an increased risk of acute GVHD in patients who received grafts from female donor being 18% for patients receiving grafts from female compared with 8% for recipients of male grafts. Donor sex was also an important influence on risk of developing chronic GVHD with cumulative incidences of chronic GVHD 9.7% for patients receiving transplants from male donors grafts compared to 24.3% for recipients of female donor grafts. We found that male recipients of grafts from female donors had a significantly higher probability for acute and chronic GVHD than male recipients with male donors or female recipients with female donors and despite the beneficial GVL effect observed in male recipients with female donors, these patients had significantly reduced survival compared with all patient/donor sex combinations, suggesting that other variables, particularly GVHD, contribute to transplantation-related mortality