Alternative donors: a match for matched sibling donors?

Abstract

Allogeneic haematopoietic stem cell transplantation (HCST) is a curative treatment for haematological malignancies. 1 Thomas E Storb R Clift RA et al. Bone-marrow transplantation (first of two parts). N Engl J Med. 1975; 292: 832-843 Crossref PubMed Scopus (1422) Google Scholar Finding a suitable donor is one of the most important steps for patients who undergo allogeneic HSCT. HLA-matched sibling donors are considered ideal, but availability of such a donor is limited to less than 30% of patients. 2 Gragert L Eapen M Williams E et al. HLA match likelihoods for hematopoietic stem-cell grafts in the US registry. N Engl J Med. 2014; 371: 339-348 Crossref PubMed Scopus (669) Google Scholar Most patients therefore need to find other suitable donors. Advances in HLA typing technology, graft-versus-host-disease (GVHD) prophylaxis, and management of complications have substantially reduced the risk of non-relapse mortality across the world, 3 Gooley TA Chien JW Pergam SA et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med. 2010; 363: 2091-2101 Crossref PubMed Scopus (1128) Google Scholar , 4 Horan JT Logan BR Agovi-Johnson MA et al. Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made?. J Clin Oncol. 2011; 29: 805-813 Crossref PubMed Scopus (153) Google Scholar and HSCT from an alternative donor has been found to be increasingly safe and feasible. 5 Luznik L O'Donnell PV Symons HJ et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2008; 14: 641-650 Summary Full Text Full Text PDF PubMed Scopus (1208) Google Scholar , 6 Wagner Jr, JE Eapen M Carter S et al. One-unit versus two-unit cord-blood transplantation for hematologic cancers. N Engl J Med. 2014; 371: 1685-1694 Crossref PubMed Scopus (212) Google Scholar The hope is that outcomes of HSCT from alternative donors such as HLA-matched unrelated donors, haploidentical donors, and umbilical cord blood donors are catching up with those of HSCT from HLA-matched sibling donors, but this question has not been addressed rigorously in a large contemporary cohort of HSCT. Outcomes of allogeneic haematopoietic stem cell transplantation from HLA-matched and alternative donors: a European Society for Blood and Marrow Transplantation registry retrospective analysisOverall survival following allogeneic stem cell transplantation is improving with substantial progress among recipients of haploidentical and cord blood HSCT. Nonetheless, the traditional donor hierarchy of matched sibling donors followed by matched unrelated donors and then other donors holds. Our findings warrant further investigation and could inform decision making and the development of donor-selection algorithms. Full-Text PDF