Selection of unrelated donors and cord blood units for hematopoietic cell transplantation: guidelines from the NMDP/CIBMTR

Abstract

Allogeneic hematopoietic cell transplantation involves consideration of both donor and recipient characteristics to guide the selection of a suitable graft. Sufficient high-resolution donor-recipient HLA match is of primary importance in transplantation with adult unrelated donors, using conventional graft-versus-host disease prophylaxis. In cord blood transplantation, optimal unit selection requires consideration of unit quality, cell dose and HLA-match. In this summary, the National Marrow Donor Program (NMDP) and the Center for International Blood and Marrow Transplant Research, jointly with the NMDP Histocompatibility Advisory Group, provide evidence-based guidelines for optimal selection of unrelated donors and cord blood units.

Figure 1.

Example of an NMDP search report. HLA assignments shown include high-resolution/2-field assignments (eg, A*02:01) and the use of multiple allele codes (eg, A*02:ANGA). These codes indicate that the assignment has not discriminated among ≥2 alternative alleles. A description of the alleles included in a specific code can be found at https://hml.nmdp.org/MacUI/. The columns labeled “HLA Typing/Match Grade/Calculation” use a letter indicating the match status of each allele at the locus (A indicates allele match; P, potential allele match; and M, mismatch) and the probability of matching both alleles at the locus (99% for the first donor at each locus). The columns labeled “Composite Predictions” provide the probability of a 10 of 10 HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 allele match (99% for the first donor) and 8 of 8 HLA-A, HLA-B, HLA-C, and HLA-DRB1 allele match (99% for the first donor). Donor DPB1 alleles and TCE group designations are provided when the donor is typed at DPB1, and DPB1 TCE Match Assignments (“DPB1 TCE”) are provided when both donor and patient are typed at DPB1. Non-HLA donor demographics are also displayed, including donor age, gender, blood type, cytomegalovirus serostatus, number of prior pregnancies, and last date the registry had contact with the donor (“Last Donor Contact”).