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Blood and Marrow Transplant Handbook pp 29–41Cite as

Hematopoietic Stem Cell Sources and Donor Selection

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Abstract

Multiple options are now available for selecting an appropriate stem cell source and donor for allogeneic hematopoietic stem cell transplantation (HSCT). Thus, decisions made while selecting the stem cell source and donor may have a critical impact on the morbidity, mortality, and ultimate success of the transplant process. Hematopoietic stem cells may be obtained from autologous or allogeneic sources and isolated from bone marrow, peripheral blood, or umbilical cord blood. The advantages and disadvantages of each of these sources are reviewed. Methods of stem cell mobilization and strategies for the difficult to mobilize patient are discussed.

Matching donor and recipient for human leukocyte antigen (HLA) haplotypes is the most important factor of a successful allogeneic stem cell transplant. Matched related donors are generally preferred over other donors due to the faster and less expensive donor workup and stem cell procurement, and lower rates of acute and chronic graft versus host disease. However, only 30 % of patients who require an allogeneic HSCT will have a suitable matched related donor. Identification of an appropriate matched unrelated donor can take 2–6 months and may not be suitable for patients with aggressive disease. Donor searches should be started early in the treatment course for these patients. The impact of other donor factors such as age, sex, parity, cytomegalovirus (CMV) status, and ABO matching may also impact outcome and are reviewed.

Alternative donor sources (umbilical cord blood or haploidentical donors) may allow for shorter time to transplant but are associated with increased risk of transplant-related complications including mortality. Intensive graft-versus-host disease (GVHD) prophylaxis is often necessary and increased risk of delayed engraftment and graft failure, prolonged defects in immune reconstitution, and increased risk of infection may be seen with these types of transplantation. A suggested algorithm for donor selection is provided.

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Bibliography

  • Alousi AM, Le_Rademacher J, Saliba RM, Appelbaum FR, Artz A, Benjamin J, et al. Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer? Blood. 2013;121:2567–73.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Barker JN, Scaradavou A, Stevens CE. Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies. Blood. 2010;115:1843–9.

    Article  CAS  PubMed  Google Scholar 

  • Bashey A, Zhang X, Sizemore CA, Mancon K, Brown S, Holland HK, et al. T-cell-replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. J Clin Oncol. 2013;31:1310–6.

    Article  CAS  PubMed  Google Scholar 

  • Bensinger W, Martin P, Storer B, Clift R, Forman S, Negrin R, et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers. N Engl J Med. 2001;344:175–181.

    Article  CAS  PubMed  Google Scholar 

  • Bittencourt H, Rocha V, Chevret S, Socie G, Esperou H, Devergie A, et al. Association of CD34 cell dose with hematopoietic recovery, infections, and other outcomes after HLA-identical sibling bone marrow transplantation. Blood. 2002;99:2726–33.

    Article  CAS  PubMed  Google Scholar 

  • Brunstein CG, Fuchs EJ, Carter SL, Karanes C, Costa LJ, Wu J, et al. Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts. Blood. 2011;118:282–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Confer D. Traditional perspective on non-HLA factors in donor search. Presented in the Selection of Adult Unrelated HSC Donors: Beyond HLA mini-symposium at 2010 BMT Tandem Meetings. Orlando, Florida. 2010.

    Google Scholar 

  • Confer DL, Abress LK, Navarro W, Madrigal A. Selection of adult unrelated hematopoietic stem cell donors: beyond HLA. Biol Blood Marrow Transplant. 2010;16(1):S8–11.

    Article  PubMed  Google Scholar 

  • Di Bartolomeo P, Santarone S, DeAngelis G, Picardi A, Cudillo L, Cerretti R, et al. Haploidentical, unmanipulated, G-CSF-primed bone marrow transplantation for patients with high-risk hematologic malignancies. Blood. 2013;121:849–57.

    Article  CAS  PubMed  Google Scholar 

  • Eapen M, Horowitz M, Klein J, Champlin R, Loberiza F, Ringden O, et al. Higher mortality after allogeneic peripheral-blood transplantation compared with bone marrow in children and adolescents. J Clin Oncol. 2004;22:4872–80.

    Article  PubMed  Google Scholar 

  • Eapen M, Rubinstein P, Zhang MJ, Stevens Cl, Kurtzberg J, Scaradavou A, et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study. Lancet. 2007;369:1947–54.

    Article  PubMed  Google Scholar 

  • Eapen M, Rocha V, Sanz G, Scaradavou A, Zhang MJ, Arcese W, et al. Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis. Lancet Oncol. 2010;11:653–60.

    Article  PubMed Central  PubMed  Google Scholar 

  • Eapen M, Klein JP, Sanz GF, Spellman S, Ruggeri A, Anasetti C, et al. Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukaemia and myelodysplastic syndrome: a retrospective analysis. Lancet Oncol. 2011;12:1214–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Kanda J, Saji H, Fukuda T, Kobayashi T, Miyamura K, Eto T, et al. Related transplantation with HLA-1 Ag mismatch in the GVH direction and HLA-8/8 allele-matched unrelated transplantation: a nationwide retrospective study. Blood. 2012;119:2409–16.

    Article  CAS  PubMed  Google Scholar 

  • Kollman C, Howe CWS, Annasetti C, Antin JH, Davies SM, Filipovich AH, et al. Donor characteristics as risk factors in recipients after transplantation of bone marrow from unrelated donors: the effect of donor age. Blood. 2001;98:2043–51.

    Article  CAS  PubMed  Google Scholar 

  • Lee S, Klein J, Haagenson M, Baxter-Lowe LC, Eapen M, Fernandez-Vina M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007;110:4576–83.

    Article  CAS  PubMed  Google Scholar 

  • Luznik L, O’Donnell PV, Symons HJ, Chen AR, Leffell MS, Zahurak M, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2008;14:641–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Micallef I, Inwards D, Dispenzieri A, Gasineau D, Gertz M, Hayman S, et al. A risk adapted approach utilizing plerixafor in autologous peripheral blood stem cell mobilization. Biol Blood Marrow Transplant. 2010;16(1):S197–8.

    Google Scholar 

  • Miller JP, Perry EH, Price TH, Bolan CD, Karanes C, Boyd TM, et al. Recovery and safety profiles of marrow and PBSC donors: experience of the national marrow donor program. Biol Blood Marrow Transplant. 2008;14(9):S29–36.

    Article  Google Scholar 

  • Passwig JR, Zhang MJ, Rocha V, Kan F, Champlin RE, Isola LM, et al. Donor characteristics affecting graft failure, graft-versus-host disease, and survival after unrelated donor transplantation with reduced-intensity conditioning for hematologic malignancies. Biol Blood Marrow Transplant. 2011;17:1855–77.

    Article  Google Scholar 

  • Peters C, Cornish J, Parikh S, Kurtzberg J. Stem cell source and outcome after hematopoietic stem cell transplantation (HSCT) in children and adolescents with acute leukemia. Pediatr Clin N Am. 2010;57:27–46.

    Article  Google Scholar 

  • Pulsipher MA, Chitphakdithai P, Logan BR, Shaw BE, Wingard JR, Lazarus HM, et al. Acute toxicities of unrelated bone marrow versus peripheral blood stem cell donation: results of a prospective trial from the national marrow donor program. Blood. 2013;121:197–206.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Stern M, Ruggeri L, Mancusi A, Bernardo ME, deAngelis C, Bucher C, et al. Survival after T cell-depleted haploidentical stem cell transplantation is improved using the mother as donor. Blood. 2008;112:2990–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Woolfrey A, Klein JP, Haagenson M, Spellman S, Petersdorf E, Oudshoorn M, et al. HLA-C antigen mismatch is associated with worse outcome in unrelated donor peripheral blood stem cell transplantation. Biol Blood Marrow Transplant. 2011;17:885–92.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Adult Blood and Marrow Transplant Program, Mayo Clinic, 5777 E. Mayo Blvd, 95054, Phoenix, AZ, USA

    Jose F. Leis

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  1. Jose F. Leis
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Correspondence to Jose F. Leis .

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Editors and Affiliations

  1. Knight Cancer Institute Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health & Science University Center for Hematologic Malignancies, Portland, Oregon, USA

    Richard T. Maziarz

  2. Knight Cancer Institute Adult Blood and Marrow Stem Cell Transplant Program, Oregon Health & Science University Center for Hematologic Malignancies, Portland, Oregon, USA

    Susan Schubach Slater

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Leis, J. (2015). Hematopoietic Stem Cell Sources and Donor Selection. In: Maziarz, R., Slater, S. (eds) Blood and Marrow Transplant Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-13832-9_3

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  • DOI: https://doi.org/10.1007/978-3-319-13832-9_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13831-2

  • Online ISBN: 978-3-319-13832-9

  • eBook Packages: MedicineMedicine (R0)

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