Donor selection in T cell-replete haploidentical hematopoietic stem cell transplantation: knowns, unknowns, and controversies

Biol Blood Marrow Transplant. 2013 Feb;19(2):180-4. doi: 10.1016/j.bbmt.2012.08.007. Epub 2012 Aug 11.

Abstract

Multiple donors are generally available for haploidentical hematopoietic stem cell transplantation. Here we discuss the factors that should be considered when selecting donors for this type of transplantation according to the currently available evidence. Donor-specific anti-HLA antibodies (DSAs) increase the risk of graft failure and should be avoided whenever possible. Strategies to manage recipients with DSAs are discussed. One should choose a full haplotype mismatch rather than a better-matched donor and maximize the dose of infused hematopoietic cells. Donor age and sex are other important factors. Other factors, including predicted natural killer cell alloreactivity and consideration of noninherited maternal alleles, are more controversial. Larger studies are needed to further clarify the role of these factors for donor selection in haploidentical hematopoietic stem cell transplantation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Donor Selection
  • HLA Antigens / immunology
  • Haplotypes
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • T-Lymphocytes / immunology*

Substances

  • HLA Antigens