Selection of donor and source of graft – Haploidentical donors and umbilical cord blood

Haema 2016; 7(2): 135-168

by Fotis Panitsas

Hematology Department and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece

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Allogeneic stem cell transplantation is potentially curative for many hematological disorders. Graft type and graft source are among the most important factors that influence the outcome of transplantation. A suitable graft can be found for almost all transplant candidates, as there are now alternative sources (haploidentical donors, cord blood) in addition to traditional graft donors (fully matched related, matched unrelated donor). Matched related donor remains first choice if available. Outcomes of matched unrelated donor transplants are now almost equivalent to matched sibling transplants. Main factors considered in the selection of unrelated donors are HLA compatibility, gender, age, CMV positivity, ABO compatibility. The search for an unrelated donor can be complex, time-consuming and expensive but can be facilitated by search tools which give estimates of the probability of match. Cord blood is a good alternative for candidates without suitable classic donors. HLA compatibility and cell dose are the main criteria for selection of cord blood units. Haploidentical donors offer advantages (near total availability, low cost, selection among different options) and are now being increasingly used thanks to new protocols that overcome limitations of the past. Donor search strategy is modified by disease phase and relapse risk, urgency of transplantation, availability of different graft sources, cost, and needs to be timely, pragmatic, coordinated and to be considered as an integral part of the overall treatment plan.