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Who is the best alternative allotransplant donor?

Abstract

Assuming that most physicians will chose an HLA-identical sibling as the best allotransplant donor, the question arises who is the best alternative donor when an HLA-identical sibling is unavailable? The most commonly used alternative donors are HLA-identical or -mismatched unrelated donors, HLA-matched or -mismatched umbilical cord blood donor or a related, HLA-haplotype-matched related donors. Each alternative donor option has advantages and disadvantages. We discuss selected aspects of these issues based on data from randomized clinical trials and observational databases. However, because there are limited data to address specific clinical settings, quantification of expert opinion is sometimes needed.

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References

  1. http://www.cibmtr.org/ReferenceCenter/SlidesReports/SummarySlides/pages/index.aspx/index.aspx accessed on 05/01/14.

  2. Luger SM, Ringden O, Zhang MJ, Perez WS, Bishop MR, Bornhauser M et al. Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML and MDS. Bone Marrow Transplant 2012; 47: 203–211.

    Article  CAS  Google Scholar 

  3. Gupta V, Tallman MS, He W, Logan BR, Copelan E, Gale RP et al. Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis. Blood 2010; 116: 1839–1848.

    Article  CAS  Google Scholar 

  4. Weisdorf D, Eapen M, Ruggeri A, Zhang MJ, Zhong X, Brunstein C et al. Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for International Blood and Marrow Transplant Research-Eurocord Analysis. Biol Blood Marrow Transplant 2014; 20: 816–822.

    Article  Google Scholar 

  5. Anasetti C, Logan BR, Lee SJ, Waller EK, Weisdorf DJ, Wingard JR et al. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med 2012; 367: 1487–1496.

    Article  CAS  Google Scholar 

  6. Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J et al. Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts. Blood 2011; 118: 282–288.

    Article  CAS  Google Scholar 

  7. Gale RP, Eapen M, Logan B, Zhang MJ, Lazarus H . Comparing therapy-options: Are observational database studies and expert opinion as good (or better) than randomized trials? Bone Marrow Transplant 2009; 43: 435–446.

    Article  CAS  Google Scholar 

  8. Breems DA, Wim LJ, Van Putten V, Huijgens PC, Ossenkoppele GJ, Verhoef GEG et al. Prognostic Index for adult patients with acute myelogenous leukemias in first relapse. J Clin Oncol 2005; 23: 1969–1978.

    Article  Google Scholar 

  9. Walter RB, Othus M, Burnett AK, Lowenberg B, Kantarjian H, Ossenkoppele GJ et al Prediction of therapeutic resistance in adult acute myeloid leukemia: Analysis of 4550 newly diagnoses patient from MRC/NCRI, HOVON/SAKK, SWOG, and MD Anderson Cancer Center. Oral and poster presentation at the 55th Annual Meeting of the American Society of Hematology, New Orleans, LA, USA, December 8, 2013.

  10. Goldman JM, Gale RP . What does MRD in leukemia really mean? Leukemia 2013; 28: 1131 doi:10.1038/leu.2013.318.

    Article  CAS  Google Scholar 

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Acknowledgements

Mary Horowitz kindly provided CIBMTR data. Yair Reisner kindly invited RPG to the HLA-Haplotype-Mismatched meeting. RPG acknowledges support from the NIHR Biomedical Research Centre funding scheme.

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Correspondence to R P Gale.

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The authors declare no conflict of interest.

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This article was published as part of a supplement, supported by WIS-CSP Foundation, in collaboration with Gilead, Milteny Biotec, Gamida Cell, Adienne Pharma and Biotech, Medac Hematology, Kiadis Pharma and Almog Diagnostic.

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Gale, R., Eapen, M. Who is the best alternative allotransplant donor?. Bone Marrow Transplant 50 (Suppl 2), S40–S42 (2015). https://doi.org/10.1038/bmt.2015.94

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