Progress in broadening the uses of marrow transplantation: donor availability

The use of bone marrow transplantation as a curative treatment for congenital immunodeficiencies is limited by the lack of available histocompatible sibling donors. The problems associated with mismatched donor transplantation and efforts to overcome these difficulties are discussed, as are results obtained in transplantation with partially matched related and unrelated donors. The use of haploidentical relative donors, an attractive option due to the wider availability of such donors, is explored, along with the consequent need for T cell depletion. Methods of T cell depletion are compared, and efforts at improving depletion methods are discussed.