Donor and graft selection strategy

A key component of the decision-making process of an allogeneic hematopoietic cell transplant is selection of the appropriate donor and graft. The best donor is an HLA-matched sibling, however, the absence of one, an alternative donor is pursued. The options of donors are: HLA-matched sibling (including one antigen/allelic mismatch); unrelated volunteer adult donor (MUD donor) (including one antigen/allelic mismatch); umbilical cord blood (UCB); and haploidentical donor. Initial allogeneic transplants were done using bone marrow grafts. However, more options are currently available. The sources of hematopoietic grafts are peripheral blood (PB); bone marrow (BM); and UCB. When a HLA-matched unrelated donor or a mismatched unit is used, it is essential to test the recipient for pre-formed donor-specific anti-HLA. Isohemagglutinin titers of the recipient are important in case of major ABO mismatch. Rh incompatibility is of little clinical significance in the transplant setting.