title: How do we choose the best donor for T-cell-replete, HLA-haploidentical transplantation?
abstract: In haploidentical stem cell transplantations (haplo-SCT), nearly all patients have more than one donor. A key issue in the haplo-SCT setting is the search for the best donor, because donor selection can significantly impact the incidences of acute and chronic graft-versus-host disease, transplant-related mortality, and relapse, in addition to overall survival. In this review, we focused on factors associated with transplant outcomes following unmanipulated haplo-SCT with anti-thymocyte globulin (ATG) or after T-cell-replete haplo-SCT with post-transplantation cyclophosphamide (PT/Cy). We summarized the effects of the primary factors, including donor-specific antibodies against human leukocyte antigens (HLA); donor age and gender; killer immunoglobulin-like receptor-ligand mismatches; and non-inherited maternal antigen mismatches. We also offered some expert recommendations and proposed an algorithm for selecting donors for unmanipulated haplo-SCT with ATG and for T-cell-replete haplo-SCT with PT/Cy.
authors.affiliation: Peking University People's Hospital and Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Beijing, Xicheng District, 100044, China.
authors.forename: Ying-Jun
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD, 21287, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 1650 Orleans Street, Baltimore, MD, 21287, USA.
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
authors.affiliation: Peking University People's Hospital and Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 South Street of Xizhimen, Beijing, Xicheng District, 100044, China. xjhrm@medmail.com.cn.|Peking-Tsinghua Center for Life Sciences, Beijing, 100871, China. xjhrm@medmail.com.cn.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D003520:Cyclophosphamide / Q000008:administration & dosage; D046148:Donor Selection / Q000379:methods*; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D017063:Outcome Assessment, Health Care; D013601:T-Lymphocytes / Q000276:immunology*; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D003520:Cyclophosphamide
keywords: Age; Donor; Donor-specific anti-human leukocyte antigen antibody; Natural killer alloreactivity; Non-inherited maternal antigen mismatch; Unmanipulated haploidentical stem cell transplantation