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Chapter 10: Unrelated Donor HSCT 207 Figure 1: Donor Search Process Patient’s HLA Typing High Resolution at HLA-A, B, C, and DRB1 Extended Family Member Typing High Resolution at HLA-A, B, C, DRB1 Adult Volunteer Donors Search of Unrelated Donor Registries Umbilical Cord Banks 7-8/8 HLA Matched Donor Identified #1 Choice 8/8 HLA Matched Donor Identified #2 Choice 7/8 HLA Matched Donor Identified or HLA 6/6 or 5/6 Umbilical Cord Blood Unit Identified with Adequate Cell Dose* HLA 4/6 Umbilical Cord Blood Unit with Adequate Cell Dose* #4 Choice *See Donor Selection (Table 5) #3 Choice HLA-matched unrelated donor. Based on the general experience with non-FA patients, donor priority accepted by major FA transplant centers is shown in Table 5. In some circumstances, greater degrees of HLA disparity might be considered acceptable. In the context of a transplant center phase I–II trial, related marrow donors mismatched at 2 or 3 antigens and unrelated umbilical cord blood donors mismatched at 3 antigens might also be used as a source of hematopoietic stem cells for transplantation. Because of proven effect on transplant outcome, other factors are considered in the selection of an alternate donor, such as age of donor, CMV serostatus, female parity (i.e., number of pregnancies), and sex match
208 <strong>Fanconi</strong> <strong>Anemia</strong>: Guidelines for Diagnosis and Management Table 5: Donor Selection: Prioritization of HSC Alternate Donors Marrow or Peripheral Blood Stem Cells • Relative (other than sibling) matched at 8 of 8 HLA-A, B, C and DRB1 alleles • Relative (including sibling) matched at 7 of 8 HLA-A, B, C and DRB1 alleles • Unrelated adult volunteer donor matched at 8 of 8 HLA-A, B, C and DRB1 alleles • Unrelated umbilical cord blood unit matched at 6 of 6 HLA-A and B (antigen level) and DRB1 (allele level), cell dose > 2.5 x 10 7 nucleated cells/kg recipient body weight Umbilical Cord Blood or Unrelated Adult Volunteer • Unrelated umbilical cord blood unit matched at 5 of 6 HLA-A and B (antigen level) and DRB1 (allele level), cell dose > 3.0 x 10 7 nucleated cells/kg recipient body weight or unrelated adult volunteer donor matched at 7 of 8 HLA-A, B, C and DRB1 alleles Unrelated Cord Blood or Haploidentical Relative • Unrelated umbilical cord blood unit matched at 4 of 6 HLA-A and B (antigen level) and DRB1 (allele level), cell dose > 4.0 x 10 7 nucleated cells/kg recipient body weight or 4-6/8 haploidentical donor or co-infusion of two partially HLA-matched cord blood units between the donor and patient. Effect of donor age on transplant outcome is under investigation, with new data suggesting lack of effect. Factors included in choice of the cord blood unit may include cord blood bank track record and ability to confirm unit identity. No data exist to indicate whether one stem cell source (8/8 marrow versus 8/8 peripheral blood versus 6/6 or 5/6 umbilical cord blood) is better or worse than another. Data in other patient populations (e.g.,
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Chapter 4 Gastrointestinal, Hepatic
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Chapter 7 Endocrine Disorders in Fa
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Chapter 14 The Adult Fanconi Anemia
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