2014 Volume 3 Issue 2 Pages 39-48
In allogeneic hematopoietic stem cell transplantation, an HLA-matched unrelated donor is the preferred alternative donor for patients who lack an HLA-identical sibling. However, for patients who have a rare haplotype, or who need immediate transplantation, other alternative donors should be considered. In this case, an HLA 1-antigen-mismatched related donor is the preferred donor, if available. A recent study showed that the use of antithymocyte globulin in HLA 1-antigen-mismatched related donor transplantation could decrease severe acute graft-versus-host disease, and improve survival. If this type of donor is not available, an HLA 1-allele-mismatched donor and an HLA-DR 1-antigen-mismatched unrelated donor are the next candidates. An unrelated cord blood unit with up to 2-antigen mismatches is also a good choice of donor, if it contains adequate total nucleated cells for engraftment. An HLA 2-3-antigen-mismatched related donor is also an attractive alternative donor, and various clinical trials of transplantation using this type of donor are ongoing. The superiority of these donors remains unknown, and should be studied in the future.
