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

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.

• Authors: Ying-Jun Chang, Leo Luznik, Ephraim J Fuchs, Xiao-Jun Huang
• Journal: Journal of hematology & oncology (J Hematol Oncol) Vol. 9 Pg. 35 (Apr 12 2016) ISSN: 1756-8722 [Electronic] England
• PMID: 27071449 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• HLA Antigens
• Cyclophosphamide

Topics

• Cyclophosphamide (administration & dosage)
• Donor Selection (methods)
• Graft vs Host Disease (immunology, prevention & control)
• HLA Antigens (immunology)
• Hematologic Neoplasms (immunology, therapy)
• Hematopoietic Stem Cell Transplantation (methods)
• Histocompatibility Testing
• Humans
• Outcome Assessment, Health Care
• T-Lymphocytes (immunology)
• Tissue Donors