Comparison of issues involved in URD marrow and UCB graft selection
. | Marrow graft . | UCB graft . |
|---|---|---|
| Available pool | Living, volunteer donors, currently ≈ 7 million | Preharvested, cryopreserved units, currently ≈ 70 000 |
| Typical donor HLA-type information in database | HLA-A, -B ± -DRB1 | HLA-A, -B, and -DRB1 |
| Acceptable donor-recipient HLA match | HLA-A, -B (serologic), and -DRB1 match, with 1 mismatch permitted for recipients < 36 y | 4 of 6 loci match at HLA-A, -B, and -DRB1 |
| Median search time | Longer, ≈ 4 mo | Shorter, < 1 mo |
| Major limiting factors to graft acquisition | HLA-match; donor attrition/availability | Fixed UCB cell content (especially for larger sized recipients) |
| Ease of rearranging date of stem cell infusion | Can be difficult | Easy |
| Potential for second HSC graft or DLI from same donor | Yes | No |
| Potential for disease transmission to recipient | ||
| CMV/EBV | Yes | No |
| Congenital disease* | No | Yes |
| Risk to donor | Uncommon (anesthesia related, surgical complication, emergent blood transfusion) | None |
. | Marrow graft . | UCB graft . |
|---|---|---|
| Available pool | Living, volunteer donors, currently ≈ 7 million | Preharvested, cryopreserved units, currently ≈ 70 000 |
| Typical donor HLA-type information in database | HLA-A, -B ± -DRB1 | HLA-A, -B, and -DRB1 |
| Acceptable donor-recipient HLA match | HLA-A, -B (serologic), and -DRB1 match, with 1 mismatch permitted for recipients < 36 y | 4 of 6 loci match at HLA-A, -B, and -DRB1 |
| Median search time | Longer, ≈ 4 mo | Shorter, < 1 mo |
| Major limiting factors to graft acquisition | HLA-match; donor attrition/availability | Fixed UCB cell content (especially for larger sized recipients) |
| Ease of rearranging date of stem cell infusion | Can be difficult | Easy |
| Potential for second HSC graft or DLI from same donor | Yes | No |
| Potential for disease transmission to recipient | ||
| CMV/EBV | Yes | No |
| Congenital disease* | No | Yes |
| Risk to donor | Uncommon (anesthesia related, surgical complication, emergent blood transfusion) | None |
HSC indicates hematopoietic stem cells; DLI, donor lymphocyte infusion.
Such as hereditary spherocytosis, thalassemia, or infant leukemia.