Role Of Alternate Donor Sources

A related HLA-identical sibling is the ideal donor for an allogeneic stem cell transplant. Unfortunately only 25-30% of patients are likely to have an HLA-identical sibling. In this older population, an HLA-matched sibling may not be eligible as a donor because of age and comorbidities. Alternative donor sources include a matched unrelated donor (MUD), matched or mismatched cord blood, or a haploidentical donor. Analysis of MUD transplants under the auspices of the National Marrow Donor Program (NMDP) shows comparable results to that of an HLA identical related transplant.16 The data with cord blood transplants is preliminary, but it has the potential to be a significant alternative source, especially with mismatched cord blood.35,36 There is insufficient data with haplo-identical transplants in this condition to recommend it outside of a clinical trial.

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