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Biol Blood Marrow Transplant. 2014 Oct;20(10):1485-92. doi: 10.1016/j.bbmt.2014.05.015. Epub 2014 May 23.

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

Author information

1
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: meapen@mcw.edu.
2
Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
3
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
4
EMMES Corporation, Rockville, Maryland.
5
Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland.

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

PMID:
24862638
PMCID:
PMC4163123
DOI:
10.1016/j.bbmt.2014.05.015
[Indexed for MEDLINE]
Free PMC Article

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