Mismatched Related and Unrelated Donors for Allogeneic Hematopoietic Cell Transplantation for Adults with Hematologic Malignancies |
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| Affiliation: | 1. Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;2. Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington;3. Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota;4. EMMES Corporation, Rockville, Maryland;5. Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland |
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| Abstract: | Two parallel phase II trials in adults with hematologic malignancies demonstrated comparable survival after reduced-intensity conditioning and transplantation of either 2 HLA-mismatched umbilical cord blood (UCB) units or bone marrow from HLA-haploidentical relatives. Donor choice is often subject to physician practice and institutional preference. Despite clear preliminary evidence of equipoise between HLA-haploidentical related donor and double unrelated donor UCB transplantation, the actual prospect of being randomized between these 2 very different donor sources is daunting to patients and their treating physicians alike. Under these circumstances, it is challenging to conduct a phase III randomized trial in which patients are assigned to the UCB or haploidentical bone marrow arms. Therefore, we aimed to provide an evidence-based review and recommendations for selecting donors for adults without an HLA-matched sibling or an HLA-matched adult unrelated donor. |
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| Keywords: | Alternative donor transplantation Donor selection algorithm Hematologic malignancy |
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