Allotransplantation in the absence of an HLA-matched sibling donor can offer numerous donor options including unrelated donor and umbilical cord blood grafting. Recently, haploidentical transplantation has exploded in popularity and worldwide use following the application of post-transplant cyclophosphamide (PTCy) for GVHD prophylaxis. Various approaches, disease states, conditioning intensities and supportive care advances have improved all these choices without demonstrable superiority of one approach versus the others. However, PTCy limits risks of GVHD; bone marrow over peripheral blood stem cells limits risks of chronic GVHD, which suggests that both these promising techniques can inform these donor and graft choices. Formal and prospective data will answer whether situationally adapted best options—tailored to each patient's disease risk and comorbidity status—will help guide future decision-making to improve patient outcomes with the least cumulative morbidity.
Bibliographical noteFunding Information:
USA NCI P30 CA077598, CA111412.
- Bone marrow
- Graft-versus-host disease
- Hematopoietic cell transplant
- Peripheral blood stem cells
- Post-transplant cyclophosphamide
- Unrelated donors