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Hematopoietic stem cell transplantation donor sources in the 21st century: choosing the ideal donor when a perfect match doesn't exist

Natasha Kekre and Joseph H. Antin
This article has an Erratum 125(6):1048

Abstract

Most patients who require allogeneic stem cell transplantation do not have a matched sibling donor, and many patients do not have a matched unrelated donor. In an effort to increase the applicability of transplantation, alternative donors such as mismatched adult unrelated donors, haploidentical related donors, and umbilical cord blood stem cell products are frequently used when a well matched donor is unavailable. We do not yet have the benefit of randomized trials comparing alternative donor stem cell sources to inform the choice of donor; however, data exist to allow some inferences based on existing observational and phase II studies. All three alternative donor sources can provide effective lymphohematopoietic reconstitution, but time to engraftment, graft failure rate, graft versus host disease, transplant-related mortality, and relapse risk vary by donor source. These factors all contribute to survival outcomes and an understanding of them should help guide clinicians when choosing amongst alternative donor sources when a matched related or matched unrelated donor is not available.

  • Submitted February 4, 2014.
  • Accepted March 30, 2014.