Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies

摘要

Two parallel phase II trials in adults with hematologic malignancies demonstrated comparable survival after reduced intensity conditioning and transplantation of either two HLA-mismatched umbilical cord blood units or bone marrow from HLA-haploidentical relatives. Donor choice is often subject to physician practice and institutional preference. Despite clear preliminary evidence of equipoise between HLA-haploidentical related donor and double unrelated donor UCB transplantation, the actual prospect of being randomized between these two very different donor sources is daunting to patients and their treating physicians alike. Under these circumstances it is challenging to conduct a phase III randomized trial in which patients are assigned to the umbilical cord blood or haploidentical bone marrow arms. Therefore, we aimed to provide an evidence-based review and recommendations for selecting donors for adults without an HLA-matched sibling or an HLA-matched adult unrelated donor.