Myeloablative Transplantation From Unrelated Donors

The outcomes in patients receiving unrelated transplants have improved more rapidly than have outcomes in patients with sibling donors. More sophisticated techniques for determining HLA compatibility and better understanding of the relative importance of matching of specific HLA antigens are largely responsible. Leukemia-free survival rates with well-matched unrelated donors in patients 40 years and younger, undergoing transplantation within a year of diagnosis, appear to be similar to those obtained with related donors.29-31 Yet, patients without histocompatible sibling donors are rarely considered for transplantation early in the course of disease. Although identification of donors and procurement of stem cells can not be accomplished as quickly as for sibling donors, preliminary studies can be used to estimate the likelihood of finding a fully matched donor. In most cases, donor stem cells can be obtained expeditiously. Appropriate patients without sibling donors should be offered this potential therapy.

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