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Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
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Donor selection in allogeneic stem cell transplantation.

Francisco Barriga1, Alberto Cardoso Martins Lima2

  • 1Section of Hematology, Oncology and Stem Cell Transplantation, Pontificia Universidad Católica de Chile, Stem Cell Collection Center, Fundación de Beneficiencia Pública DKMS, Santiago, Chile.

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Donor selection for hematopoietic stem cell transplantation is evolving with advances in human leukocyte antigen (HLA) typing. While matched siblings remain ideal, alternative donors are increasingly viable options.

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Area of Science:

  • Hematology
  • Immunogenetics
  • Transplantation Science

Background:

  • Advances in human leukocyte antigen (HLA) characterization and donor pool expansion have increased donor availability for allogeneic hematopoietic stem cell transplantation.
  • New platforms for haploidentical transplantation further broaden donor options.

Purpose of the Study:

  • To analyze donor types, HLA and non-HLA factors influencing donor selection, and comparative outcomes in hematologic malignancies.
  • To review the current landscape of donor selection in allogeneic hematopoietic stem cell transplantation.

Main Methods:

  • Review of recent literature on HLA typing, donor selection algorithms, and comparative outcome studies.
  • Analysis of retrospective studies comparing different donor types and their impact on transplantation success.

Main Results:

  • HLA typing advances incorporate more loci and alleles (e.g., HLA A, B, C, DRB1, DQB1, DPB1) into donor selection.
  • A consensus favors matched sibling donors, followed by matched unrelated donors, with alternative donors (haploidentical, mismatched unrelated, cord blood) gaining traction.
  • Factors like donor age, patient condition, transplant urgency, and cost are challenging the traditional donor selection hierarchy.

Conclusions:

  • The choice of donor in hematopoietic stem cell transplantation is complex, balancing HLA matching with clinical and logistical factors.
  • Understanding the unique characteristics and outcomes associated with each donor type is crucial for optimizing patient treatment.
  • Ongoing research and comparative studies are essential to refine donor selection strategies for hematologic malignancies.