Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies

Biol Blood Marrow Transplant. 2014 Oct;20(10):1485-92. doi: 10.1016/j.bbmt.2014.05.015. Epub 2014 May 23.


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.

Keywords: Alternative donor transplantation; Donor selection algorithm; Hematologic malignancy.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Bone Marrow Transplantation*
  • Cord Blood Stem Cell Transplantation*
  • Decision Trees
  • Gene Expression
  • HLA Antigens / genetics
  • HLA Antigens / immunology
  • Haplotypes
  • Hematologic Neoplasms / genetics
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / therapy*
  • Histocompatibility Testing
  • Humans
  • Myeloablative Agonists / therapeutic use
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Siblings
  • Survival Analysis
  • Transplantation Conditioning / methods*
  • Transplantation, Homologous
  • Unrelated Donors*


  • HLA Antigens
  • Myeloablative Agonists