HSCT: Donor selection for patients with ALL

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Published: 23 Jan 2020
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Prof Sebastian Giebel - The Maria Skłodowska-Curie Institute of Oncology, Gliwice, Poland

Prof Sebastian Giebel speaks to ecancer at the 2020 ALL Assembly meeting in Frankfurt about the importance of donor selection in haematopoietic stem cell transplantation (HSCT).

He describes the selection process, where matched siblings are usually the first choice for donation and that the availability of donors is no longer a limiting factor.

Prof Giebel also states that haploidentical transplants are equivalent to unrelated donor transplants - which can be offered to most patients.

He describes that large registries and retrospective data is used to conduct comparisons between the two donor types and discusses the future use of HSCT.

 

Haematopoietic stem cell transplantation is still a very important part of the treatment of acute lymphoblastic leukaemia. At the same time this is one of the most frequent indications for haematopoietic stem cell transplantation in haematology. The number of transplants continues growing and a major factor that impacts this growth is increasing availability of donors. In fact, nowadays we have a very wide range of potential donors including matched siblings, which is the first choice, then unrelated fully matched or mismatched unrelated and with cord bloods and haploidentical donors. So altogether the availability of donors is no longer a limitation for transplantation in acute lymphoblastic leukaemia.

Furthermore, we have evidence that results of haploidentical transplants are equivalent to unrelated donor transplants, both matched and mismatched, and therefore we can offer really this option for almost all patients who are in need.

The number of haplo transplants in acute lymphoblastic leukaemia is sharply growing in recent years but according to the results of the BMT we should first choose post-transplant  cyclophosphamide, it’s our platform for immunosuppression in this setting. Then we should rather use bone marrow than peripheral blood as a source of stem cells.

Have there been any recent studies comparing the donor types?

The comparisons between various types of donors are performed mainly on a retrospective basis by big registries, including EBMT and CIBMTR. Unfortunately there are very few prospective data and because that is comparing haploidentical and unrelated donor transplants that are ongoing we will have to wait several years for the results.

Where do you see the use of HSCT in 5 years from now?

I expect haploidentical transplants will become still more and more popular and probably the proportion between unrelated and haploidentical transplants will approach 50% within five years. That’s my assumption.