title: Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies.
abstract: Two parallel phase II trials in adults with hematologic malignancies demonstrated comparable survival after reduced-intensity conditioning and transplantation of either 2 HLA-mismatched umbilical cord blood (UCB) 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 2 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 UCB 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.
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: meapen@mcw.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.affiliation: Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Donnell
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.affiliation: EMMES Corporation, Rockville, Maryland.
authors.forename: Juan
authors.initials: J
authors.lastname: Wu
authors.affiliation: EMMES Corporation, Rockville, Maryland.
authors.forename: Kate
authors.initials: K
authors.lastname: Barowski
authors.affiliation: EMMES Corporation, Rockville, Maryland.
authors.forename: Adam
authors.initials: A
authors.lastname: Mendizabal
authors.affiliation: Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
mesh_terms: D016026:Bone Marrow Transplantation; D036101:Cord Blood Stem Cell Transplantation; D003663:Decision Trees; D015870:Gene Expression; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D019653:Myeloablative Agonists / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists
keywords: Alternative donor transplantation; Donor selection algorithm; Hematologic malignancy