How do we choose the best donor for T-cell-replete, HLA-haploidentical transplantation?

Ying-Jun Chang,Ephraim J Fuchs,Leo Luznik,Xiao-Jun Huang

doi:10.1186/s13045-016-0265-2

Abstract

In haploidentical stem cell transplantations (haplo-SCT), nearly all patients have more than one donor. A key issue in the haplo-SCT setting is the search for the best donor, because donor selection can significantly impact the incidences of acute and chronic graft-versus-host disease, transplant-related mortality, and relapse, in addition to overall survival. In this review, we focused on factors associated with transplant outcomes following unmanipulated haplo-SCT with anti-thymocyte globulin (ATG) or after T-cell-replete haplo-SCT with post-transplantation cyclophosphamide (PT/Cy). We summarized the effects of the primary factors, including donor-specific antibodies against human leukocyte antigens (HLA); donor age and gender; killer immunoglobulin-like receptor-ligand mismatches; and non-inherited maternal antigen mismatches. We also offered some expert recommendations and proposed an algorithm for selecting donors for unmanipulated haplo-SCT with ATG and for T-cell-replete haplo-SCT with PT/Cy.

Highlights

Allogeneic hematopoietic cell transplantation (SCT) remains the only curative therapy for a majority of malignant hematologic diseases [1,2,3,4,5,6,7]
Because most patients have more than one potential haplo donor, this raises an important question [68]: Who is the best donor for TCR haplo-SCT? haplo donor selection may have a significant impact on the incidence of acute and chronic graft-versus-host disease (GVHD), transplant-related mortality (TRM), and relapse, in addition to overall survival (OS) [9,10,11,12,13, 19, 34, 36, 69,70,71,72]
We summarize donor-related variables that are associated with clinical outcomes, and we provide a rationale for using a personalized algorithm for donor selection in unmanipulated haploSCT with anti-thymocyte globulin (ATG) [1, 52,53,54,55] or post-transplantation cyclophosphamide (PT/Cy) [1, 36, 58, 59]

Summary

Introduction

Allogeneic hematopoietic cell transplantation (SCT) remains the only curative therapy for a majority of malignant hematologic diseases [1,2,3,4,5,6,7]. We discuss the effects of HLA mismatching on transplant outcomes in patients treated with unmanipulated haplo-SCT with ATG [1, 52,53,54,55] or with PT/ Cy [1, 36, 58, 59].

Results

Conclusion