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

Publication Type
Journal Article
Year of Publication
Eapen, Mary; O'Donnell, Paul; Brunstein, Claudio G; Wu, Juan; Barowski, Kate; Mendizabal, Adam; Fuchs, Ephraim J
Biol Blood Marrow Transplant
Date Published
2014 Oct
Bone Marrow Transplantation; Cord Blood Stem Cell Transplantation; Decision Trees; Gene Expression; Haplotypes; Hematologic Neoplasms; Histocompatibility Testing; HLA Antigens; Humans; Myeloablative Agonists; Randomized Controlled Trials as Topic; Recurrence; Siblings; Survival Analysis; Transplantation Conditioning; Transplantation, Homologous; Unrelated Donors

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.