Abstract
Unrelated umbilical cord blood (UCB) and haploidentical grafts have been used for allogeneic hematopoietic stem and progenitor cell (HSPC) transplantation in patients without a related or non-related human leukocyte antigen (HLA)-matched donor. The less stringent HLA-matching requirement in both sources raises an important possibility for patients in need of urgent transplantation to treat any hematological disease. Selection of the best alternative donor is a difficult task that will depend on donor criteria, center experience, patient disease conditions, and risk, among others. Most comparisons available in scientific publications between both graft sources are obtained from retrospective analysis in wide time windows and a heterogeneous number of patients, types of disease, disease stages, previous treatments, graft source, conditioning regimen, graft vs. host disease (GVHD) approach, and evaluable endpoints. There is also an evident impact of the economic traits since low-income countries must consider less expensive treatments to satisfy the needs of the patients in the most effective possible path. Therefore, haploidentical transplantation could be an appealing option, even though it has not been completely established if any chronic treatment derived from the procedure could become a higher cost. In Colombia, there is a huge experience in UCB transplantation especially in units of pediatric transplantation where benign indications are more common than in adults. Due to the availability of a public UCB bank and HLA high-resolution typing in Colombia, there is a wider inventory of cord blood donors. Unfortunately, we do not have an unrelated bone marrow donor registry, so UCB is an important source along with haploidentical transplantation to consider in decision-making. This minireview focuses on comparing the main issues associated with the use of both HSCP sources and provides tools for physicians who face the difficult decision between these alternative donor sources.
Highlights
Hematopoietic stem and progenitor cell (HSPC) transplantation is a potentially curative treatment that has been used for different disorders that affect hematopoiesis [1, 2]
It is known that only 30% of the patients who require an hematopoietic stem and progenitor cell (HSPC) transplant have a fully human leukocyte antigen (HLA)-matched sibling donor [6, 9, 10] and an alternative graft source, such as a haploidentical donor and umbilical cord blood (UCB) units, turns out very important for the clinical practice
We focused on verifying the information reported in the literature only for malignant disease in which umbilical cord blood and haploidentical transplantation are compared simultaneously as a two-arm design, retrospective or prospective, with overall survival or progression-free survival (PFS) evaluated as clinical endpoints and including information regarding the time of engraftment
Summary
Hematopoietic stem and progenitor cell (HSPC) transplantation is a potentially curative treatment that has been used for different disorders that affect hematopoiesis [1, 2]. Since the transplantation involves a bone marrow reconstitution in the patient, matching of human leukocyte antigen (HLA) between donor and recipient is probably the most considered and debating topic in the literature [3,4,5,6]. It is known that only 30% of the patients who require an HSPC transplant have a fully HLA-matched sibling donor [6, 9, 10] and an alternative graft source, such as a haploidentical donor and UCB units, turns out very important for the clinical practice. We focused on verifying the information reported in the literature only for malignant disease in which umbilical cord blood and haploidentical transplantation are compared simultaneously as a two-arm design, retrospective or prospective, with overall survival or progression-free survival (PFS) evaluated as clinical endpoints and including information regarding the time of engraftment. There are several reports of the clinical results and experience with each graft source separately, we did not include them, considering the aforementioned variability
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