Selection of the optimal donor for allogeneic hematopoietic cell transplantation (allo-HCT) involves a comprehensive evaluation of several critical factors. Human leukocyte antigen (HLA) matching has proved to be the most likely crucial parameter in this process. However, several additional criteria can significantly influence allo-HCT outcomes.

Dr. Heather Stefanski will discuss the patient’s likelihood and probability of having a fully HLA-matched donor and finding a suitable donor prior to allo-HCT. She will summarize the historical barriers to transplant, especially for racially and ethnically diverse patients. A special focus will be put on new strategies, including post-transplant cyclophosphamide and abatacept, which can allow for safe and effective use of HLA-mismatched donor sources such as haploidentical donors and mismatched unrelated donors.  Dr. Stefanski will highlight the research evidence that shows alternative donors are a viable and safe option for many allo-HCT recipients.

Dr. Mohamad Mohty will discuss the non-HLA factors which can contribute to further optimizing the selection of a donor prior to allo-HCT. These factors include the age of the donor (especially data favoring younger donors), recipient-donor gender mismatch and its impact on graft-versus-host disease, cytomegalovirus serostatus, and blood type compatibility. Dr Mohty will also briefly discuss the potential role of killer immunoglobulin-like receptor (KIR) matching, and donor-recipient kinship.

By integrating HLA and non-HLA variables into the donor selection process, one can significantly enhance the outcome of patients who are candidates for allo-HCT.