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

• Published in: Journal of hematology and oncology Vol. 9; no. 1; pp. 35 - 12
• Main Authors: Chang, Ying-Jun, Luznik, Leo, Fuchs, Ephraim J., Huang, Xiao-Jun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.04.2016; BioMed Central; BMC
• Subjects: Age; Antigens; Blood diseases; Bone marrow; Care and treatment; Clinical outcomes; Complications and side effects; Cyclophosphamide - administration & dosage; Disease prevention; Donor; Donor Selection - methods; Donor-specific anti-human leukocyte antigen antibody; Graft versus host disease; Graft vs Host Disease - immunology; Graft vs Host Disease - prevention & control; Health aspects; Hematologic Neoplasms - immunology; Hematologic Neoplasms - therapy; Hematology; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility antigens; Histocompatibility Testing; HLA Antigens - immunology; HLA histocompatibility antigens; Humans; Influence; Leukemia; Medical research; Natural killer alloreactivity; Non-inherited maternal antigen mismatch; Oncology; Outcome Assessment (Health Care); Review; Stem cells; T-Lymphocytes - immunology; Tissue Donors; Transplantation; Transplants & implants; Unmanipulated haploidentical stem cell transplantation; China; Unmanipulated haploidentical stem cell transplantation; Natural killer alloreactivity; Donor; Donor-specific anti-human leukocyte antigen antibody; Non-inherited maternal antigen mismatch; Age
• ISSN: 1756-8722; 1756-8722
• DOI: 10.1186/s13045-016-0265-2

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.