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.
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Financial disclosure: This work was supported in part by grant U10 HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute and grant U24 CA76518 from the National Heart, Lung, and Blood Institute, the National Cancer Institute, and the National Institute of Allergy and Infectious Disease .
- Alternative donor transplantation
- Donor selection algorithm
- Hematologic malignancy