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Donor Sources and Donor Selection for Hematopoietic Cell Transplant

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Hematopoietic Cell Transplantation in Children with Cancer

Part of the book series: Pediatric Oncology ((PEDIATRICO))

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Abstract

Hematopoietic stem cells (HSCs) may be obtained by collection of bone marrow, mobilization and collection of peripheral blood stem cells (PBSCs), or collection of umbilical cord blood (UCB). The choice of HSC product depends upon the disease being treated, the availability of a suitable donor, and, to a certain extent, donor size. Autologous HSC provides a readily obtainable reservoir of cells for reconstitution of hematopoietic function after high-dose therapy without risk of graft-versus-host disease (GVHD); however, the indications for autologous hematopoietic cell transplant (HCT) are limited to high-risk lymphoma or certain solid tumors. Allogeneic HCT requires availability of a suitable donor, determined by human leukocyte antigen (HLA) compatibility and physical fitness for the procedure. The inheritance pattern of HLA haplotypes results in the potential for matching HLA antigens at the genetic level among full siblings (HLA genotypic identity). Donor-recipient HLA genotypic identity confers the lowest risk for immunologically mediated complications, graft rejection and GVHD. Most patients referred for allogeneic HCT lack an HLA-matched sibling; thus, an alternative donor must be identified. The most important factor in selection of the optimal unrelated donor is the degree of HLA match. Because phase of disease at the time of transplant is the most significant predictor of survival, the most important variable to consider at the start of the donor search is the urgency of the transplant procedure. By employing a strategy that identifies an acceptable donor in the shortest period of time, and that subsequently refines the search to optimize donor characteristics, transplants can be performed at the time most appropriate for the patient, with the best donor available within that time frame.

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Acknowledgements

We thank Anne Thompson for assistance in preparing the manuscript.

This work was supported by NCI/NHLBI Blood and Marrow Clinical Research Network grant HL 069246.

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Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Ann E. Woolfrey

  2. EUROCORD, Hospital Saint Louis, Paris, France

    Vanderson Rocha

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  1. Ann E. Woolfrey
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Correspondence to Ann E. Woolfrey .

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Editors and Affiliations

  1. University of Cincinnati, Cincinnati, Ohio, USA

    Franklin O. Smith

  2. George Washington University, Washington, Washington, USA

    Gregory H. Reaman

  3. Division of Hematology/Oncology, Dept. of Internal Medicine, University of Cincinnati College of Medicine, Madeira, Ohio, USA

    Judy M. Racadio

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Woolfrey, A.E., Rocha, V. (2014). Donor Sources and Donor Selection for Hematopoietic Cell Transplant. In: Smith, F., Reaman, G., Racadio, J. (eds) Hematopoietic Cell Transplantation in Children with Cancer. Pediatric Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39920-6_2

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