"I love HSCTJourney"

2022-05-06 15:53:50

Join the JourneyLandscape TodayA Challenging JourneyHSCT DisparitySeeking ChangeWhat's NextJoin the JourneyLet’s expand the horizon. Expand TheHorizonEach allogeneic hematopoietic stem cell transplant (allo-HSCT) is a personalized journey.No paths are exactly alike,but the outlook is the same:hope on the horizon.Join us on a new journey to extend the promise of allo-HSCT to more patients in need.As cell therapy innovations redefine expectations of allo-hsct, what new perspectives will lead us to:Open the fieldwith more transplants for more waiting patients? smooth the pathwith optimized solutions and better outcomes? clear the waywith a straightforward experience for patients? Continue to find out more about today's landscape.THE LANDSCAPE TODAYTHE LANDSCAPE TODAYOver 18,000 new patients with hematologic malignancies are considered for allogeneic transplant each year, initiating their journey of hope.1 ALLO-HSCT OFFERS A CRITICAL ADVANTAGE to these patients by significantly improving survival rates when they proceed to transplant earlier in their treatment journey.2,3 ADVANCES IN THE LAST FEW DECADES HAVE SIGNIFICANTLY IMPROVED ALLO-HSCT ACCESS AND OUTCOMES. SELECT TO FIND OUT MORE: 19702 ">Advent of unrelated donor registries 19804,5">Introduction of umbilical cord blood (UCB) as a viable graft source 19904">Process of peripheral blood stem cell collection 4">Emergence of reduced intensity conditioning regimens 20006">Increased sensitivity of chimerism analysis methods 20107,8">Improvement of post-transplant treatments for haploidentical recipients 20209">Developmentof novel pharmaceutical agents as new treatment options First established in 1974, this introduced a monumental shift that extended access to new donor sources for patients without access to a matched related donor.2 CONTINUE TO LEARN ABOUT CHALLENGES ALONG THE TRANSPLANT JOURNEY.ADVANCES IN THE LAST FEW DECADES HAVE SIGNIFICANTLY IMPROVED ALLO-HSCT ACCESS AND OUTCOMES. SELECT TO FIND OUT MORE:2 "> 1970Advent of unrelated donor registries 4,5"> 1980Introduction of umbilical cord blood (UCB) as a viable graft source 4"> 1990Process of peripheral blood stem cell collection 4">Emergence of reduced intensity conditioning regimens 6"> 2000Increased sensitivity of chimerism analysis methods 7,8"> 2010Improvement of post-transplant treatments for haploidentical recipients 9"> 2020Developmentof novel pharmaceutical agents as new treatment options First established in 1974, this introduced a monumental shift that extended access to new donor sources for patients without access to a matched related donor.2 CONTINUE TO LEARN ABOUT CHALLENGES ALONG THE TRANSPLANT JOURNEY.A CHALLENGING JOURNEYA CHALLENGING JOURNEYAllogeneic transplant is a POTENTIALLY CURATIVE TREATMENT for patients with hematologic malignancies, but despite our achievements as a community, the transplant journey remains challenging.2 Every year, MORE THAN 10,000 PATIENTS who could benefit from allo-HSCT do not receive a transplant, and those who do experience anxiety and face challenges across the entire transplant journey.10,11 Racial disparities contribute to the lack of access to allo-transplant, and MINORITY PATIENTS ARE FAR LESS LIKELY to find a suitable donor.12,13,14 Navigate the patient journey to learn more about steps and barriers along the way. Patient Selection and Consideration for TransplantOnce referred to a transplanter, the determination of allo-HSCT eligibility and decision to proceed is complex, and reliant on clinical, non-clinical, and donor factors.11 DISEASE TYPE AND STAGE:Long-term transplant outcomes vary considerably based on the specific type and stage of disease, with advanced-stage diseases approximately doubling the mortality risk of patients compared with early-stage diseases.18 Therefore, patients with high-risk disease must be able to proceed to transplant promptly.19PATIENT HEALTH AND PERFORMANCE STATUS:Stem cell transplanters look for stable health and check several performance status criteria, including adequate major organ function and self-reported mental health, to assess eligibility for allo-HSCT.11PATIENT AGE AND MEDICAL COMORBIDITIES:Increased patient age and compromised organ functions are risk factors that can impact transplant outcomes. The hematopoietic cell transplantation (HCT)-Comorbidity Index (HCT-CI) score has been validated to predict the risk of non-relapse mortality (NRM) and estimated survival after allo-HSCT, with increased HCT-CI scores being predictive of increased risks of NRM and overall mortality.20–23 Furthermore, a retrospective study conducted in 2007 proposed an updated composite-age HCT-CI that has also been shown to have a similar utility.23,24">Learn More About Clinical Barriers LOGISTICAL AND FINANCIAL BARRIERS:Transplant is a challenging treatment that requires social support. Those without access to a caregiver are often not considered as candidates, as are those unable to travel to a transplant center or without the ability to overcome economic barriers.25PSYCHOSOCIAL FACTORS:Even though transplantation is the only curative option for these patients, it is still a tremendous life-changing event. Patients benefit from strong social support as well as from balanced mental well-being, since noncompliance and lack of motivation have significant impact on overall transplant outcomes.11PATIENT DECISION NOT TO PROCEED WITH TRANSPLANT:Some patients who are eligible ultimately decide not to undergo transplantation because they do not wish to spend time in the hospital, are uncertain about the success rate of the treatment, or have concerns about their overall quality of life during and after transplant.26,27">Learn more about Non-Clinical Barriers Donor sourcing and acquisitionThe search for a donor source requires the full transplant team and may be unpredictable due to donor accessibility and the possibility of donor attrition. Selection of a donor source is ultimately at the discretion of the transplanter, and acquisition can range from 1 to 14+ months.15,16 AVAILABILITY OF DONOR:For decades, transplant has relied mainly on adult donors, related or unrelated, with matched related donor (MRD) being the gold standard, and transplanters weighing advantages and compromises of other available sources.17 When an MRD is not available, patients often rely on unrelated donor registries to find a donor graft source; however, the likelihood of finding a match is still low for racial and ethnic minority groups as they are underrepresented in the registries.13 Even when an optimal unrelated donor is identified, stem cell transplanters recognize that not all potential donors will decide to undergo further testing and proceed with the donation.15 There is a much higher registry attrition rate for racial minorities compared with that for White patients.28SUITABILITY OF DONOR SOURCE:Determining the optimal source of hematopoietic cells, whether peripheral blood (PB), bone marrow (BM), or umbilical cord blood (UCB), requires special consideration as outcomes of allo-HSCT vary according to the graft source. Recent studies have advocated for the use of BM grafts for haplo HSCT and matched unrelated donor (MUD) HSCT, since allogeneic peripheral blood progenitor cell (PBPC) transplants are associated with worse long-term outcomes and an increased risk of GvHD compared to BM transplants.29–31 Despite the advantages of UCB in procuring a rapid cell source with lower incidence of GvHD and less stringent HLA-matching requirements, today’s use of UCB is limited by the insufficient number of stem cells obtained from UCB, and thus is associated with delayed engraftment, higher risk for graft failure, and higher rates of infectious complications.32 Regardless of the donor source, stem cell transplanters always seek the best possible HLA matching, since it is strongly associated with better outcomes. Increased risk for acute GvHD, chronic GvHD, treatment-related mortality (TRM), treatment failure, and overall mortality is observed for each individual mismatched HLA locus.33TIMING OF DONOR SOURCE ACQUISITION:The time from initiation of preliminary search to acquisition of a donor source is about 3 months, but varies for each patient and can extend anywhere from 1 to 14+ months.16 Research shows that early referral is a key determinant that can impact HSCT outcomes and affect survival. Therefore, delayed acquisition of the donor source can have significant implications for patients with high-risk disease who generally benefit from rapid transplantation.19DONOR AGE:In instances when a donor match is identified, the age of the donor must still be considered, as older donor age is associated with reduced overall survival (OS) and disease-free survival, as well as increased treatment-related mortality and higher relapse rate.34–36 Patients undergoing MRD, MUD, or MMUD HSCT for hematological malignancies presented with a 17% excess risk for Overall Survival (OS) outcomes for every additional decade of donor age >30 years.37">Learn more about Donor-Related Barriers Patient PreparationPatients undergo myeloablative or reduced intensity conditioning before their infusion. In preparation for transplantation, and for the subsequent recovery period after undergoing allo-HSCT, patients need to secure a full-time caregiver and a strong support system.2,11 TransplantationDay Zero represents the day of infusion of stem cells and also the beginning of the monitoring period, which requires careful planning and preparation by the transplant team, the patient, and their caregiver.2 Recovery, Monitoring, and Long-term Follow-upThe time from transplant to engraftment is a key indicator of transplant success, and the days following transplant are critical for monitoring of patient outcomes. This period of monitoring continues even after engraftment and discharge, with transplanters consistently following up to mitigate complications and track progress.2,17BARRIERS THROUGHOUT THE JOURNEY PREVENT PATIENTS FROM EVEN BEING CONSIDERED FOR AND PROCEEDING WITH TRANSPLANT, EXCLUDING THEM FROM THIS POTENTIAL CURE.CONTINUE TO LEARN MORE ABOUT RACIAL DISPARITIES TO ACCESS.HSCT DISPARITYHSCT DISPARITYFor minority patients, additional barriers exist throughout the journey, with ACCESS TO A DONOR VARYING GREATLY BY RACE. In the U.S., African Americans are 2–3 times less likely than White Americans to find a matched unrelated donor, and disproportionately receive a mismatched graft: 41% of the time, as compared to 14% for White Americans.38-40 Probability of identifying an 8/8 HLA-matched unrelated available adult donor by race13White patients of European descent75%White patients of Middle Eastern or North African descent46%Hispanic patients (includes Mexican, Hispanic South or Central American, and Hispanic Caribbean)34%–40%Asian patients (includes Chinese, Korean, South Asian, Japanese, Filipino, Southeast Asian, and Vietnamese)27%–42%Black patients (includes African American, African, Black South or Central American, and Black Caribbean) 16%–19%Data obtained from the National Marrow Donor Program registry was used to predict the likelihood of identifying a suitable donor for patients in each group.SOLUTIONS TODAY OFTEN FOCUS ON ALTERNATIVE DONOR SOURCES, BUT STILL, INEQUITIES REMAIN.41,42Cord Blood increases minority patients’ access to a suitable graft with less strict HLA matching as compared to adult donors.43,44 However, a single unit of cord blood may not supply enough hematopoietic cells for engraftment often requiring a second cord blood unit, preventing widespread adoption of cord blood transplantation.13Haplo-related Transplant promises an almost universal match for many patients, but practical and clinical limitations pose considerable risks.45 Most patients of African ancestry do not have a suitable haplo-related donor; in a single-center study, only 44% of African Americans were able to identify a suitable HLA-haplo-related relative.42,46 Haplo-related transplants also often lead to high incidences of graft rejection and graft versus host disease (GvHD).45Continue to learn about advancements in the allo-HSCT landscape.SEEKING CHANGESEEKING CHANGEDetermination of transplant success is complex, and requires EVALUATION OF MULTIPLE PERFORMANCE INDICATORS across a period of time.Transplant physicians and healthcare providers must manage outcomes while also seeking opportunities to increase equity in transplant. But today, as NEW VISTAS IN CELL ENGINEERING AND TECHNOLOGY EMERGE, innovations will lead us to the next step in expectations for donor sources and transplant outcomes. WHERE ARE NEW PROMISING ADVANCEMENTS HAPPENING IN THE ALLO-HSCT LANDSCAPE? Development of optimal conditions for expansion and preservation of cellular functionality and phenotype during expansion may lead to critical advancements in cellular therapy.56">EX VIVO EXPANSIONultra-high-resolution next-generation sequencing (NGS) technology has emerged and replaced the more conventional HLA typing methodologies, providing more sensitive, faster, and more cost-effective information on HLA typing mismatching, facilitating access to the best-matched donors.47-52">NOVEL HLA TYPINGMyeloablative conditioning regimens (MAC) are usually preferred for young and fit patients, while reduced-intensity conditioning (RIC) regimens are recommended for elderly, unfit patients with comorbidities. In trying to balance GvHD and the GvL effect, physicians aspire to minimize toxicity by individualizing the conditioning regimens to each patient and searching for alternatives to total body irradiation (TBI), which, despite its efficacy, can cause secondary malignancies and organ damage.57">OPTIMIZATION OF CONDITIONING REGIMENSThe essential foundation for every transplant is the donor source – and its quality, degree of HLA matching, and cellular composition may determine the short- and long-term effects.33,53 So much depends on these selected cells: to restore and renew.When multiple similarly matched donor sources are available, transplanters select for optimized cellularity and cellular compositions, particularly with regard to CD34+ cell counts and T cells, as they may play a major role in transplant outcomes.53">SELECTION OF OPTIMAL DONOR SOURCEnew approaches have shown promising results, especially in the setting of steroid-refractory acute and chronic GvHD.57-63">GvHD PROPHYLAXIS AND TREATMENT54 Strategies, such as the use of cytokines and the selective depletion of certain cellular types, may present a promising approach to preserving GvL effects while reducing GvHD.55">GRAFT ENGINEERING AND ADOPTIVE IMMUNOTHERAPY64,65 For example, cytomegalovirus reactivation has been associated with poor allo-HSCT outcomes and can induce graft failure or non-relapse mortality.66 New antiviral drugs that are active against cytomegalovirus infections will help in improving short- and long-term outcomes for patients undergoing allo-HSCT.67">SUPPORTIVE CAREA better understanding of racial disparities in the transplant community will help reduce systemic inequities and support access to transplant for all populations. Innovations are also being researched that may mitigate limitations and build on the successes of cord blood and haploidentical-related transplant methods so that more patients have access to a potential cure.">HEALTH EQUITY AND ACCESS AMONG MINORITIESEx vivo expansion of stem cells may help to alleviate the issue of cell shortage for transplantation purposes. Development of optimal conditions for expansion and preservation of cellular functionality and phenotype during expansion may lead to critical advancements in cellular therapy.56 CONTINUE TO SEE HOW YOU CAN JOIN THE JOURNEY.WHERE ARE NEW PROMISING ADVANCEMENTS HAPPENING IN THE ALLO-HSCT LANDSCAPE? Development of optimal conditions for expansion and preservation of cellular functionality and phenotype during expansion may lead to critical advancements in cellular therapy.56">EX VIVO EXPANSIONultra-high-resolution next-generation sequencing (NGS) technology has emerged and replaced the more conventional HLA typing methodologies, providing more sensitive, faster, and more cost-effective information on HLA typing mismatching, facilitating access to the best-matched donors.47-52">NOVEL HLA TYPINGMyeloablative conditioning regimens (MAC) are usually preferred for young and fit patients, while reduced-intensity conditioning (RIC) regimens are recommended for elderly, unfit patients with comorbidities. In trying to balance GvHD and the GvL effect, physicians aspire to minimize toxicity by individualizing the conditioning regimens to each patient and searching for alternatives to total body irradiation (TBI), which, despite its efficacy, can cause secondary malignancies and organ damage.57">OPTIMIZATION OF CONDITIONING REGIMENSThe essential foundation for every transplant is the donor source – and its quality, degree of HLA matching, and cellular composition may determine the short- and long-term effects.33,53 So much depends on these selected cells: to restore and renew.When multiple similarly matched donor sources are available, transplanters select for optimized cellularity and cellular compositions, particularly with regard to CD34+ cell counts and T cells, as they may play a major role in transplant outcomes.53">SELECTION OF OPTIMAL DONOR SOURCEnew approaches have shown promising results, especially in the setting of steroid-refractory acute and chronic GvHD.57-63">GvHD PROPHYLAXIS AND TREATMENT54 Strategies, such as the use of cytokines and the selective depletion of certain cellular types, may present a promising approach to preserving GvL effects while reducing GvHD.55">GRAFT ENGINEERING AND ADOPTIVE IMMUNOTHERAPY64,65 For example, cytomegalovirus reactivation has been associated with poor allo-HSCT outcomes and can induce graft failure or non-relapse mortality.66 New antiviral drugs that are active against cytomegalovirus infections will help in improving short- and long-term outcomes for patients undergoing allo-HSCT.67">SUPPORTIVE CAREA better understanding of racial disparities in the transplant community will help reduce systemic inequities and support access to transplant for all populations. Innovations are also being researched that may mitigate limitations and build on the successes of cord blood and haploidentical-related transplant methods so that more patients have access to a potential cure.">HEALTH EQUITY AND ACCESS AMONG MINORITIESEx vivo expansion of stem cells may help to alleviate the issue of cell shortage for transplantation purposes. Development of optimal conditions for expansion and preservation of cellular functionality and phenotype during expansion may lead to critical advancements in cellular therapy.56 CONTINUE TO SEE HOW YOU CAN JOIN THE JOURNEY.LET'S EXPAND THE HORIZONLET'S EXPANDTHE HORIZONWhat can we gain from new science, streamlined processes, and additional support across the patient journey?What can we gain from new science, streamlined processes, and additional support across the patient journey?Open the fieldToday, 10,000+ patients must proceed with alternative treatments other than allo-HSCT – how can innovations and recent advancements reshape the allo-HSCT journey to make it more inclusive?10 smooth the pathToday, we must choose compromises in donors across match, donor age, availability, and profile – where can we advance expectations to overcome existing barriers that prevent still too many patients from proceeding to transplant? clear the wayToday, patients wonder, worry, and wait throughout their journey – where can we accelerate research to alleviate areas of anxiety and uncertainty for patients? Join the JourneyThis site is intended for US healthcare professionals only. © 2022 Gamida Cell. GC-US-00038. | Privacy Policy | Terms of Use | Cookie Policy | UnsubscribeREFERENCESU.S. Department of Health and Human Services: Health Resources and Services Administration. Bone Marrow and Cord Blood Donation and Transplantation. Perumbeti A, et al. Hematopoietic stem cell transplantation. Medscape. https://emedicine.medscape.com/article/208954-overview. Accessed August 2018. Phelan, R., Arora, M., Chen, M. Current use and outcome of hematopoietic stem cell transplantation: CIBMTR US summary slides, 2020. Henig I, Zuckerman T. Hematopoietic stem cell transplantation-50 years of evolution and future perspectives. Rambam Maimonides Med J. 2014;5(4):e0028. Mayani H, Wagner JE, Broxmeyer HE. Cord blood research, banking, and transplantation: achievements, challenges, and perspectives. Bone Marrow Transplant. 2019;55(1):48-61. Tozzo P, Delicati A, Zambello R, Caenazzo L. Chimerism Monitoring Techniques after Hematopoietic Stem Cell Transplantation: An Overview of the Last 15 Years of Innovations. Diagnostics (Basel). 2021;11(4):621. D'Souza A, Fretham C, Lee SJ, et al. Current Use of and Trends in Hematopoietic Cell Transplantation in the United States. Biol Blood Marrow Transplant. 2020;26(8):e177-e182. Slade M, Fakhri B, Savani BN, Romee R. Halfway there: the past, present and future of haploidentical transplantation. Bone Marrow Transplant. 2017;52(1):1-6. ARM Global Regenerative Medicine & Advanced Therapy Sector Report: H1 2021. Besse KL, Preussler JM, Murphy EA, et al. Estimating demand and unmet need for allogeneic hematopoietic cell transplantation in the United States using geographic information systems. J Oncol Pract. 2015;11(2):e120-e130. Hamadani M, Craig M, Awan FT, Devine SM. How we approach patient evaluation for hematopoietic stem cell transplantation. Bone Marrow Transplant. 2010;45(8):1259-1268. Majhail NS, Nayyar S, Santibañez ME, Murphy EA, Denzen EM. Racial disparities in hematopoietic cell transplantation in the United States. Bone Marrow Transplant. 2012;47(11):1385-1390. Gragert L, Eapen M, Williams E, et al. HLA match likelihoods for hematopoietic stem-cell grafts in the U.S. registry. N Engl J Med. 2014;371(4):339-348. Joshua TV, Rizzo JD, Zhang MJ, et al. Access to hematopoietic stem cell transplantation: effect of race and sex. Cancer. 2010;116(14):3469-3476. Switzer GE, Dew MA, Stukas AA, Goycoolea JM, Hegland J, Simmons RG. Factors associated with attrition from a national bone marrow registry. Bone Marrow Transplant. 1999;24(3):313-319. Ciurea SO, Bittencourt MCB, Milton DR, et al. Is a matched unrelated donor search needed for all allogeneic transplant candidates?. Blood Adv. 2018;2(17):2254-2261. Carreras E, Dufour C, Mohty M, Kröger N, eds. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies. 7th ed. Cham (CH): Springer; 2019. Lee SJ, Klein J, Haagenson M, et al. High-resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood. 2007;110(13):4576-4583. Dehn J, Spellman S, Hurley CK, et al. Selection of unrelated donors and cord blood units for hematopoietic cell transplantation: guidelines from the NMDP/CIBMTR. Blood. 2019;134(12):924-934. Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106:2912-2919. Sorror ML, Logan BR, Zhu X, et al. Prospective validation of the predictive power of the hematopoietic cell transplantation comorbidity index: a Center for International Blood and Marrow Transplant research study. Biol Blood Marrow Transplant. 2015;21:1479-1487. ElSawy M, Storer BE, Pulsipher MA, et al. Multi-centre validation of the prognostic value of the haematopoietic cell transplantation- specific comorbidity index among recipient of allogeneic haematopoietic cell transplantation. Br J Haematol. 2015;170:574-583. National Comprehensive Cancer Network. Hematopoietic Cell Transplantation (HCT): Pre-Transplant Recipient Evaluation and Management of Graft-Versus-Host Disease (Version 3.2021). https://www.nccn.org/professionals/physician_gls/pdf/hct.pdf. Accessed August 12, 2021. Sorror ML, Storb RF, Sandmaier BM, et al. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol. 2014;32(29):3249-3256. Pidala J, Craig BM, Lee SJ, Majhail N, Quinn G, Anasetti C. Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2013;48(1):63-67. Palmer J, Scherber R, Girardo M, et al. Patient Perspectives Regarding Allogeneic Bone Marrow Transplantation in Myelofibrosis. Biology of Blood and Marrow Transplantation. 2019;25(2):398-402. Liso A, Neri M, Maglietta F, La Russa R, Turillazzi E. Hematopoietic Stem Cell Transplantation: A Bioethical Lens. Stem Cells Int. 2017;2017:1286246. Switzer GE, Bruce JG, Myaskovsky L, et al. Race and ethnicity in decisions about unrelated hematopoietic stem cell donation. Blood. 2013;121(8):1469. Lee SJ, Logan B, Westervelt P, et al. Comparison of patient-reported outcomes in 5-year survivors who received bone marrow vs peripheral blood unrelated donor transplantation: long-term follow-up of a randomized clinical trial. JAMA Oncol. 2016;2:1583-1589. Alousi A, Wang T, Hemmer MT, et al. Peripheral blood versus bone marrow from unrelated donors: bone marrow allografts have improved long-term overall and graft-versus-host disease-free, relapse-free survival. Biol Blood Marrow Transplant. 2019;25:270-278. Anasetti C, Logan BR, Lee SJ, et al. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med. 2012;367:1487-1496. Gluckman E, Rocha V, Boyer-Chammard A, et al. Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group. N Engl J Med. 1997;337(6):373-381. Pidala J, Lee SJ, Ahn KW, et al. Nonpermissive HLA-DPB1 mismatch increases mortality after myeloablative unrelated allogeneic hematopoietic cell transplantation. Blood. 2014;124(16):2596-2606. Bastida JM, Cabrero M, Lopez-Godino O, et al. Influence of donor age in allogeneic stem cell transplant outcome in acute myeloid leukemia and myelodysplastic syndrome. Leuk Res. 2015;39(8):828-834. Kollman C, Spellman SR, Zhang MJ, et al. The effect of donor characteristics on survival after unrelated donor transplantation for hematologic malignancy. Blood. 2016;127(2):260-267. Canaani J, Savani BN, Labopin M, et al. Donor age determines outcome in acute leukemia patients over 40 undergoing haploidentical hematopoietic cell transplantation. Am J Hematol. 2018;93(2):246-253. DeZern, A.E., Franklin, C., et al. (2021). Relationship of donor age and relationship to outcomes of haploidentical transplantation with posttransplant cyclophosphamide. Blood Adv. 5(5): 1360-8. Wilkerson J. Racial minorities face a dearth of stem cell donors. Science in the News. https://sitn.hms.harvard.edu/flash/2019/racial-minorities-trouble-with-stem-cell-transplants-a-dearth-of-donors. Published November 2019. Accessed November 2021. Be The Match. Why Ethnicity Matters When Donating Bone Marrow. https://bethematch.org/transplant-basics/matching-patients-with-donors/how-does-a-patients-ethnic-background-affect-matching. Accessed November 2021. Be the Match. Five Year Strategic Plan 2019–2023. https://cdn.fs.pathlms.com/EEmJaYfJTlGv1TFVxIUJ. Published 2020. Accessed November 2021. Fuchs EJ, O'Donnell PV, Eapen M, et al. Double unrelated umbilical cord blood vs HLA-haploidentical bone marrow transplantation: the BMT CTN 1101 trial. Blood. 2021;137(3):420-428. Kosuri S, Wolff T, Devlin SM, et al. Prospective Evaluation of Unrelated Donor Cord Blood and Haploidentical Donor Access Reveals Graft Availability Varies by Patient Ancestry: Practical Implications for Donor Selection. Biol Blood Marrow Transplant. 2017;23(6):965-970. Kindwall-Keller TL, Ballen KK. Umbilical cord blood: The promise and the uncertainty. Stem Cells Transl Med. 2020;9(10):1153-1162. Barker JN, Boughan K, Dahi PB, et al. Racial disparities in access to HLA-matched unrelated donor transplants: a prospective 1312-patient analysis. Blood Adv. 2019;3(7):939-944. Fabricius WA, Ramanathan M. Review on Haploidentical Hematopoietic Cell Transplantation in Patients with Hematologic Malignancies. Adv Hematol. 2016;2016:5726132. Solomon SR, Martin AS, Zhang MJ, et al. Optimal Donor for African Americans with Hematologic Malignancy: HLA-Haploidentical Relative or Umbilical Cord Blood Transplant. Biol Blood Marrow Transplant. 2020;26(10):1930-1936. Barone JC, Saito K, Beutner K, et al. HLA-genotyping of clinical specimens using Ion Torrent-based NGS. Hum Immunol. 2015;76:903–9. Gabriel C, Danzer M, Hackl C, et al. Rapid high-throughput human leukocyte antigen typing by massively parallel pyrosequencing for high-resolution allele identification. Hum Immunol. 2009;70:960–4. Weimer ET, Montgomery M, Petraroia R, et al. Performance characteristics and validation of next-generation sequencing for human leucocyte antigen typing. J Mol Diagn. 2016;18:668–75. Gandhi MJ, Ferriola D, Lind C, et al. Assessing a single targeted next generation sequencing for human leukocyte antigen typing protocol for interoperability, as performed by users with variable experience. Hum Immunol. 2017;78:642–8. Wittig M, Anmarkrud JA, Kassens JC, et al. Development of a high-resolution NGS-based HLA-typing and analysis pipeline. Nucleic Acids Res. 2015;43:e70. Boegel S, Lower M, Schafer M, et al. HLA typing from RNA-Seq sequence reads. Genome Med. 2012;4:102. Fleischhauer K, Hsu KC, Shaw BE. Prevention of relapse after allogeneic hematopoietic cell transplantation by donor and cell source selection. Bone Marrow Transplant. 2018;53(12):1498-1507. Zhang P, Tey S-K. Adoptive T Cell Therapy Following Haploidentical Hematopoietic Stem Cell Transplantation. Frontiers in Immunology. 2019;10. Chang YJ, Zhao XY, Huang XJ. Strategies for Enhancing and Preserving Anti-leukemia Effects Without Aggravating Graft-Versus-Host Disease. Front Immunol. 2018;9:3041. Published 2018 Dec 21. Tajer P, Pike-Overzet K, Arias S, Havenga M, Staal F. Ex Vivo Expansion of Hematopoietic Stem Cells for Therapeutic Purposes: Lessons from Development and the Niche. Cells. 2019;8(2):169. Ozturk C and Bozdag SC. touchREVIEWS in Oncology & Haematology. 2021;17(1):28-35 Zeiser R, von Bubnoff N, Butler J, et al. Ruxolitinib for glucocorticoid-refractory acute graft-versus-host disease. N Engl J Med. 2020;382:1800-10. Jagasia M, Lazaryan A, Bachier CR, et al. ROCK2 Inhibition With Belumosudil (KD025) for the Treatment of Chronic Graft-Versus-Host Disease. J Clin Oncol. 2021;39(17):1888-1898. Miklos D, Cutler CS, Arora M, et al. Ibrutinib for chronic graft-versus-host disease after failure of prior therapy. Blood. 2017;130:2243–50. Danylesko I, Bukauskas A, Paulson M, et al. Anti-α4β7 integrin monoclonal antibody (vedolizumab) for the treatment of steroid-resistant severe intestinal acute graft-versus-host disease. Bone Marrow Transplant. 2019;54:987–93. Magenau JM, Goldstein SC, Peltier D, et al. α1-Antitrypsin infusion for treatment of steroid-resistant acute graft-versus host disease. Blood. 2018;131:1372–9. Kurtzberg J, Abdel-Azim H, Carpenter P, et al. A phase 3, single-arm, prospective study of remestemcel-l, ex vivo culture expanded adult human mesenchymal stromal cells for the treatment of pediatric patients who failed to respond to steroid treatment for acute graft-versus-host disease. Biol Blood Marrow Transplant. 2020;26:845–54. Gratwohl A, Brand R, Frassoni F, et al. Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant. 2005;36:757–69. Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis. 2010;50:1091–100. Teira P, Battiwalla M, Ramanathan M, et al. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. Blood. 2016;127:2427–38. Marty FM, Ljungman P, Chemaly RF, et al. Letermovir prophylaxis for cytomegalovirus in hematopoietic-cell transplantation. N Engl J Med. 2017;377:2433–44. Do you consent to our use of cookies as described in our Cookie Policy, including for analytics, to personalize content, and to tailor and measure ads?Accept