Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, DC 20007, United States.
Histocompatibility Laboratory Services, American Red Cross, Penn-Jersey Region, Philadelphia, PA 19123, United States.
Hum Immunol. 2022 Oct;83(10):674-686. doi: 10.1016/j.humimm.2022.08.007. Epub 2022 Aug 26.
Since the first allogeneic hematopoietic stem cell transplantation (HCT) was performed by Dr. E. Donnall Thomas in 1957, the field has advanced with new stem cell sources, immune suppressive regimens, and transplant protocols. Stem cells may be collected from bone marrow, peripheral or cord blood from an identical twin, a sibling, or a related or unrelated donor, which can be human leukocyte antigen (HLA) matched, mismatched, or haploidentical. Although HLA matching is one of the most important criteria for successful allogeneic HCT (allo-HCT) to minimize graft vs host disease (GVHD), prevent relapse, and improve overall survival, the novel immunosuppressive protocols for GVHD prophylaxis offered improved outcomes in haploidentical HCT (haplo-HCT), expanding donor availability for the majority of HCT candidates. These immunosuppressive protocols are currently being tested with the HLA-matched and mismatched donors to improve HCT outcomes further. In addition, fine-tuning the DPB1 mismatching and discovering the B leader genotype and mismatching may offer further optimization of donor selection and transplant outcomes. While the decision about a donor type largely depends on the patient's characteristics, disease status, and the transplant protocols utilized by an individual transplant center, there are general approaches to donor selection dictated by donor-recipient histocompatibility and the urgency for HCT. This review highlights recent advances in understanding critical factors in donor selection strategies for allo-HCT. It uses clinical vignettes to demonstrate the importance of making timely decisions for HCT candidates.
自 1957 年 E. Donnall Thomas 博士进行首例异基因造血干细胞移植（HCT）以来，该领域已通过新的干细胞来源、免疫抑制方案和移植方案取得进展。干细胞可从骨髓、同卵双胞胎、兄弟姐妹或相关或不相关供体的外周血或脐带血中采集，可与人类白细胞抗原（HLA）匹配、不匹配或单倍体相合。虽然 HLA 匹配是异基因 HCT（allo-HCT）成功的最重要标准之一，可最大程度减少移植物抗宿主病（GVHD）、预防复发并提高总体生存率，但新型 GVHD 预防免疫抑制方案在单倍体相合 HCT（haplo-HCT）中提供了更好的结果，扩大了大多数 HCT 候选者的供体可用性。这些免疫抑制方案目前正在与 HLA 匹配和不匹配供体一起进行测试，以进一步提高 HCT 结果。此外，精细调整 DPBI 错配并发现 B 领导基因型和错配可能进一步优化供体选择和移植结果。虽然供体类型的决定在很大程度上取决于患者的特征、疾病状态和个体移植中心使用的移植方案，但根据供受者组织相容性和 HCT 的紧迫性，有一般的供体选择方法。本综述强调了理解 allo-HCT 供体选择策略中关键因素的最新进展。它使用临床病例演示了为 HCT 候选者及时做出决策的重要性。
