Clinical Manual of Blood and Bone Marrow Transplantation

Syed A. Abutalib, Parameswaran Hari, Syed A. Abutalib, Parameswaran Hari

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781119095453
• eBook ISBN: 9781119095477
• Edition: 1
• Topic: Medicine
• Subtopic: Hematology

Providing the practicing and trainee hematologist with a practical and immediately applicable compendium of answers the Clinical Manual of Blood and Bone Marrow Transplantation covers the spectrum of the hematopoietic cell transplant specialty, in particular practical issues in transplant patient care, and the set up and functioning of a transplant program.  

• Supplies the practicing and trainee hematologist with a practical and immediately applicable compendium of answers to clinical questions
• Covers the spectrum of the hematopoietic cell transplant specialty, in particular practical issues in transplant patient care, and the set up and functioning of a transplant program
• Contains concise chapters written with a focus on tables, algorithms and figures to aid rapid referral
• Benefits from expert contributions from an international authorship

CHAPTER 1
Donor and graft selection strategy

Ayman Saad¹, Marisa B. Marques², and Shin Mineishi³

¹ Blood & Marrow Transplantation and Cellular Therapy Program, University of Alabama at Birmingham, Birmingham, AL, USA

² Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA

³ Bone Marrow Transplant Program, Penn State Hershey Medical Center, Hershey, PA, USA

Introduction

A key component of the decision‐making process of an allogeneic hematopoietic cell transplant is selection of the appropriate donor and graft. The best donor is an HLA‐matched sibling. However, this option is available only for one third of patients. While the choice of a graft type is often determined by the transplant center preference and experience, there are advantages and disadvantages with each option.

What are the donor options?

In the absence of an HLA‐matched sibling, an alternative donor is pursued. The options of donors are:

1. HLA‐matched sibling (including one antigen/allelic mismatch)
2. Unrelated volunteer adult donor (MUD donor) (including one antigen/allelic mismatch).
3. Umbilical cord blood (UCB).
4. Haploidentical donor.

What are the graft sources?

Initial allogeneic transplants were done using bone marrow grafts. However, more options are currently available. The sources of hematopoietic grafts are:

1. Peripheral blood (PB).
2. Bone marrow (BM).
3. UCB.

Donor options

HLA matching is the most relevant factor when choosing a donor. Details of HLA typing are explained in Chapter 2. Some pertinent details are outlined next.

HLA matching for donor selection

HLA antigens are either “high expression” such as HLA‐A, B, C (class I), DRB1 (class II), or “low expression” such as DQB1, DPB1, and DRB3/4/5 (all class II). The “high expression” antigens play a pivotal role in the transplant setting because of high antigen density on the cells. (We will refer to DRB1, DQB1, and DPB1 as DR, DQ, and DP, respectively, throughout this chapter.) An HLA‐matched sibling is usually the preferred donor. A haploidentical donor (≥ 4/8 match) is defined as a first degree relative that shares at least one full haplotype with the recipient (i.e., it cannot be mismatched in both loci of any HLA alleles).

For unrelated donors, HLA matching at the allele level of HLA‐A, B, C and DRB1 (8 alleles) is done according to National Marrow Donor Program (NMDP) recommendation. An ideal donor is 8/8 HLA‐match. When there is more than one 8/8 HLA‐matched donor, additional HLA matching at the DQ and DP may be helpful to identify a better candidate (see Chapter 2). For example, with DQ typing, 10/10 matched donors may be favored. On the other hand, DP matching is only seen in about 20% of 10/10 HLA‐matched unrelated donors. Nevertheless, groups of “permissive” versus “non‐permissive” mismatching have been identified based on cross‐reactivity profiles. Permissive mismatching (found in ~70% of 10/10 HLA‐matched donors) means two mismatched DP alleles will have a favorable outcome (less non‐relapse mortality (NRM)) similar to a HLA‐matched DP. The use of DQ and DP matching has not been universally recommended.

Each single locus mismatching in classical HLA loci (A, B, C, and DRB1) is associated with ~10% reduction in overall survival particularly for “early stage” disease. Earlier data showed that the worst “bone marrow” mismatches were HLA‐A or HLA‐DRB1 alleles, and the worst PB mismatch was HLA‐C antigen. However, more recent data showed that the type (allele/antigen) and locus (HLA‐A, B, C, or DR) of mismatch have equal impact on survival outcome. The only exception is a favorable outcome with the permissive mismatch of C*03:03/C*03:04.

HLA matching of UCB

Due to the immaturity of UCB T‐cells, HLA matching is less stringent when using this graft source. UCB should be at least a 4/6 (A/B and DRB1) match using HLA‐A and B (DNA‐based low resolution/antige...

Table of contents

• Cover
• Title Page
• Table of Contents
• Contributors
• Preface
• CHAPTER 1: Donor and graft selection strategy
• CHAPTER 2: HLA typing and implications
• CHAPTER 3: Risk‐benefit assessment in allogeneic hematopoietic transplant: Factors, scores, and models
• CHAPTER 4: Donor and recipient pre‐transplant evaluation
• CHAPTER 5: Autologous and allogeneic progenitor cell mobilization
• CHAPTER 6: Hematopoietic stem and progenitor cell collection by apheresis
• CHAPTER 7: Hematopoietic cell processing
• CHAPTER 8: Graft manipulation
• CHAPTER 9: Graft‐versus‐host disease prophylaxis
• CHAPTER 10: Acute lymphoblastic leukemia
• CHAPTER 11: Acute myeloid leukemia
• CHAPTER 12: Myelodysplastic syndromes
• CHAPTER 13: Chronic myelogenous leukemia
• CHAPTER 14: Philadelphia chromosome negative myeloproliferative neoplasms
• CHAPTER 15: Chronic lymphocytic leukemia
• CHAPTER 16: Hodgkin Lymphoma
• CHAPTER 17: Indolent lymphomas
• CHAPTER 18: Diffuse large B‐cell lymphoma
• CHAPTER 19: Mantle cell lymphoma
• CHAPTER 20: T‐cell lymphoma
• CHAPTER 21: Primary CNS lymphoma
• CHAPTER 22: Autologous hematopoietic transplant in multiple myeloma
• CHAPTER 23: Allogeneic hematopoietic transplant in multiple myeloma
• CHAPTER 24: Light‐chain amyloidosis
• CHAPTER 25: Autoimmune disorders
• CHAPTER 26: Testicular cancer
• CHAPTER 27: Sickle cell disease
• CHAPTER 28: Hematopoietic cell transplant in thalassemia
• CHAPTER 29: Fanconi anemia
• CHAPTER 30: Immunodeficiency disorders
• CHAPTER 31: Inherited metabolic disorders
• CHAPTER 32: Aplastic anemia and paroxysmal nocturnal hemoglobinuria
• CHAPTER 33: HIV infection and transplantation
• CHAPTER 34: Engraftment and graft failure
• CHAPTER 35: Immune reconstitution and tolerance
• CHAPTER 36: Donor lymphocyte infusion
• CHAPTER 37: Diagnosis and treatment of acute graft‐versus‐host disease
• CHAPTER 38: Diagnosis and treatment of chronic graft‐versus‐host disease
• CHAPTER 39: Prevention and treatment of infection
• CHAPTER 40: Early non‐infectious complications after hematopoietic cell transplantation
• CHAPTER 41: Post‐transplant lymphoproliferative disorders
• CHAPTER 42: Survivorship issues after transplantation
• Index
• End User License Agreement