Current donor selection strategies for allogeneic hematopoietic cell transplantation

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic stem cell transplantation (HCT) has undergone substantial advancements since its inception in 1957.
• Stem cell sources include bone marrow, peripheral blood, and cord blood from various donor types (identical twin, sibling, related, unrelated).
• Human leukocyte antigen (HLA) matching is crucial for minimizing graft-versus-host disease (GVHD), preventing relapse, and improving survival in HCT.

Purpose of the Study:

• To review recent progress in understanding critical factors influencing donor selection strategies for allogeneic HCT.
• To highlight how novel immunosuppressive protocols enhance outcomes in haploidentical HCT (haplo-HCT), broadening donor availability.
• To underscore the importance of timely donor selection decisions for HCT candidates.

Main Methods:

• Review of current literature and clinical practices in allogeneic HCT donor selection.
• Analysis of the impact of HLA matching, mismatches, and novel genetic factors (DPB1, B leader genotype) on transplant outcomes.
• Utilization of clinical vignettes to illustrate decision-making processes in donor selection.

Main Results:

• Novel immunosuppressive protocols have improved outcomes in haploidentical HCT, expanding donor options.
• Fine-tuning HLA matching, including DPB1 and B leader genotypes, shows potential for further optimizing donor selection and transplant success.
• Donor selection decisions are influenced by patient characteristics, disease status, transplant protocols, and histocompatibility.

Conclusions:

• Advances in immunosuppression and a deeper understanding of histocompatibility are expanding the feasibility and success of allogeneic HCT.
• Optimized donor selection strategies, considering HLA matching and genetic factors, are critical for improving HCT outcomes.
• Timely and informed donor selection is paramount for maximizing the benefits of HCT for eligible patients.