Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA.
Blood. 2014 Jul 17;124(3):334-43. doi: 10.1182/blood-2014-02-514760. Epub 2014 Jun 9.
Most patients who require allogeneic stem cell transplantation do not have a matched sibling donor, and many patients do not have a matched unrelated donor. In an effort to increase the applicability of transplantation, alternative donors such as mismatched adult unrelated donors, haploidentical related donors, and umbilical cord blood stem cell products are frequently used when a well matched donor is unavailable. We do not yet have the benefit of randomized trials comparing alternative donor stem cell sources to inform the choice of donor; however, the existing data allow some inferences to be made on the basis of existing observational and phase 2 studies. All 3 alternative donor sources can provide effective lymphohematopoietic reconstitution, but time to engraftment, graft failure rate, graft-versus-host disease, transplant-related mortality, and relapse risk vary by donor source. These factors all contribute to survival outcomes and an understanding of them should help guide clinicians when choosing among alternative donor sources when a matched related or matched unrelated donor is not available.
大多数需要异体干细胞移植的患者没有匹配的同胞供体，许多患者也没有匹配的无关供体。为了增加移植的适用性，当没有合适的供体时，通常会使用其他供体，如不合型的成人无关供体、半相合相关供体和脐带血干细胞产品。我们还没有随机试验的好处来比较替代供体干细胞来源，以告知供体的选择；然而，现有的数据允许根据现有的观察性和 2 期研究做出一些推断。所有 3 种替代供体来源都可以提供有效的淋巴造血重建，但植入时间、移植物失败率、移植物抗宿主病、移植相关死亡率和复发风险因供体来源而异。这些因素都影响生存结果，了解这些因素应该有助于指导临床医生在没有匹配的相关或匹配的无关供体时选择替代供体来源。
