Donor selection for allo-HSCT: NMDP/CIBMTR guidelines

Guidelines from the National Marrow Donor Program (NMDP) and the Center for International Blood and Marrow Transplant Research (CIBMTR) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) donor selection, in the context of novel graft-versus-host disease (GvHD) prophylaxis approaches, were recently published in Transplantation and Cellular Therapy by Jimenez Jimenez et al.

Key data: Concurrent donor searches using search prognosis scores – based on patient human leukocyte antigen (HLA) and ancestry, rather than sequential approaches – are recommended, as HLA-matched unrelated donors (MUDs) and HLA-mismatched unrelated donors (MMUDs) have shown comparable outcomes when post-transplant cyclophosphamide (PTCy)-based GvHD prophylaxis is used. When selecting between MMUDs and available haploidentical donor sources, absence of donor-specific HLA antibodies (DSA), donor availability, and younger donor age should be considered. Donors aged ≤30 years should be prioritized to maximize overall survival (OS).

Key learning: Advances in GvHD prophylaxis have improved outcomes in alternative donor allo-HSCT; therefore, contemporary donor selection should shift from strict HLA-matching hierarchies to integrated strategies, considering both HLA compatibility and non-HLA factors, including donor age.