Updated evidence-based guidelines for optimal selection of unrelated donors and cord blood units for HCT

The National Marrow Donor Program® (NMDP) and the Center for International Blood and Marrow Transplant Research® (CIBMTR®), jointly with the NMDP Histocompatibility Advisory Group, have released updated evidence-based guidelines for the optimal selection of unrelated donors and cord blood units for hematopoietic cell transplantation (HCT).

For transplantation with adult unrelated donors, the guidelines state that high-resolution donor-recipient human leukocyte antigen (HLA) match is of primary importance to patient outcomes. The recommendation is for patients and donors to be typed by DNA-based methods at high-resolution for HLA-A, -B, -C, -DRB1, and -DPB1 loci.

The guidelines state that among non-HLA factors, increasing age of the donor is the only factor associated with higher recipient mortality. Recommendations on other non-HLA factors to consider when selecting adult unrelated donors for HCT are included for:
• Donor availability
• Natural killer (NK) cell alloreactivity
• Patient sensitization to HLA antigens
• Permissive versus non-permissive DPB1 mismatches

For cord blood unit transplantation, the guidelines state that optimal unit selection requires consideration of unit quality, cell dose, and HLA match at HLA-A, -B, -C, and -DRB1 loci.

The minimum cell dose recommendations for single cord blood units are a total nucleated cell (TNC) dose of 3.0 x 10^7/kg recipient body weight and a pre-freeze CD34+ dose of 1.5 x 10^5/kg recipient body weight for a single unit or 1.0 x 10^5/kg per unit for double unit infusion. 

Dehn J, et al., Blood

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