Allogeneic Hematopoietic Cell Donor Selection: Contemporary Guidelines from the NMDP/CIBMTR

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Allogeneic hematopoietic cell transplantation (HCT) is a vital curative treatment for various hematologic conditions.
• Traditional donor selection prioritizes HLA-matched donors over alternative, HLA-mismatched sources.
• Emerging data suggest improved outcomes with alternative donors when using novel graft-versus-host disease (GVHD) prophylaxis strategies.

Purpose of the Study:

• To review current evidence on donor selection in allogeneic HCT.
• To provide expert recommendations for donor selection algorithms in the context of novel GVHD prophylaxis.
• To identify key unanswered questions in the field of HCT donor selection.

Main Methods:

• Review of recent evidence from prospective clinical trials.
• Analysis of high-quality observational studies.
• Formulation of expert panel recommendations.

Main Results:

• Novel GVHD prophylaxis strategies enhance the feasibility of using alternative donors.
• Non-HLA factors (donor characteristics, systemic factors) are increasingly important in donor selection.
• Current donor selection rubrics may need re-evaluation.

Conclusions:

• The landscape of donor selection for allogeneic HCT is evolving.
• Emphasis is shifting towards non-HLA factors, especially with advanced GVHD prophylaxis.
• Further research is needed to optimize donor selection algorithms for improved HCT outcomes.