Selecting the best haploidentical donor

The substantial evidence of the safety of human leukocyte antigen (HLA)-haploidentical (haplo) blood or marrow transplantation (BMT) has led to its increasing utilization. When prioritizing HLA-matched grafts, patients frequently have few or no donors from whom to choose. However, a given patient may have multiple suitable haplo donors. Therefore factors other than HLA-match become critical for selecting the best donor. We recommend a donor selection algorithm based on the donor-specific antibodies, ABO match, donor age, donor sex, and cytomegalovirus (CMV) serostatus match. Despite provocative initial evidence, further studies are warranted to determine whether there is any benefit to selecting a haplo donor based on the number of HLA-mismatches, natural killer cell alloreactivity, or the presence of non-inherited maternal HLA antigens.