Recent studies suggest improved survival in patients with severe aplastic anemia receiving hematopoietic cell transplant (HCT) from unrelated donors with longer telomeres. Here, we tested whether this effect is generalizable to patients with acute leukemia. From the Center for International Blood and Marrow Transplant Research (CIBMTR®) database, we identified 1097 patients who received 8/8 HLA-matched unrelated HCT for acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL) between 2004 and 2012 with myeloablative conditioning, and had pre-HCT blood sample from the donor in CIBMTR repository. The median age at HCT for recipients was 40 years (range ≤1–68), and 32 years for donors (range = 18–61). We used qPCR for relative telomere length (RTL) measurement, and Cox proportional hazard models for statistical analyses. In a discovery cohort of 300 patients, longer donor RTL (>25th percentile) was associated with reduced risks of relapse (HR = 0.62, p = 0.05) and acute graft-versus-host disease II–IV (HR = 0.68, p = 0.05), and possibly with a higher probability of neutrophil engraftment (HR = 1.3, p = 0.06). However, these results did not replicate in two validation cohorts of 297 and 488 recipients. There was one exception; a higher probability of neutrophil engraftment was observed in one validation cohort (HR = 1.24, p = 0.05). In a combined analysis of the three cohorts, no statistically significant associations (all p > 0.1) were found between donor RTL and any outcomes.

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Author information


  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    • Shahinaz M. Gadalla
    •  & Sharon A. Savage
  2. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA

    • Tao Wang
  3. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA

    • Tao Wang
  4. Telomere Diagnostics, Menlo Park, CA, USA

    • David Loftus
    • , Marsha Blauwkamp
    •  & Jason Shelton
  5. Cancer Genomics Research Laboratory, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    • Casey Dagnall
    • , Belynda Hicks
    •  & Kristine Jones
  6. Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA

    • Casey Dagnall
    • , Belynda Hicks
    •  & Kristine Jones
  7. Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA

    • Michael Haagenson
    • , Stephen R. Spellman
    •  & Stephanie J. Lee
  8. Clinical Persona, Inc., East Palo Alto, CA, USA

    • Ljubomir Buturovic
    •  & Damjan Krstajic
  9. Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany

    • Katharina Fleischhauer
  10. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    • Katharine C. Hsu
  11. Pediatric BMT, University of Colorado, Aurora, CO, USA

    • Michael R. Verneris
  12. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    • Stephanie J. Lee


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Conflict of interest

DL, DK, and LB are paid consultant for Telomere Diagnostics, Inc. LF, MB, and JS are employees at Telomere Diagnostics, Inc. The remaining authors declare that they have no conflict of interest.

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Correspondence to Shahinaz M. Gadalla.

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