Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies

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.

Keywords: Alternative donor transplantation; Donor selection algorithm; Hematologic malignancy.

Conflict of interest statement

Conflict of Interest

The authors declare none

Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

The 3-year probability of overall survival after HLA-haploidentical bone marrow (A), progression-free survival after HLA-haploidentical bone marrow (B), overall survival after double UCB (C) and progression-free survival after double UCB (D) transplantation.

Figure 2

The 3-year probability of non-relapse mortality after HLA-haploidentical bone marrow (A), relapse after HLA-haploidentical bone marrow (B), non-relapse mortality after double UCB (C) and relapse after double UCB (D) transplantation.

Figure 3

Donor selection algorithm Abbreviations MRD = matched related donor; URD = unrelated donor; MURD = HLA-mismatched unrelated donor; UCB = umbilical cord blood; DSA = donor specific antibody