What question did this study set out to answer?

The aim is to identify donor selection strategies that reduce GVHD risk while enhancing GVM efficacy in alloHCT.

May 3, 20260 citations

Optimal donor selection for transplant to reduce GVHD risk and augment graft-versus-malignancy efficacy.

Key Points

The aim is to identify donor selection strategies that reduce GVHD risk while enhancing GVM efficacy in alloHCT.
Discussed HLA matching importance and implications for donor selection
Reviewed advancements like post-transplant cyclophosphamide for GVHD prevention
Highlighted strategies to optimize donor selection without increasing GVHD risk
Demonstrated that HLA-mismatched alloHCT can be safe with new GVHD prevention techniques
Improved transplantation outcomes when employing optimal donor selection strategies
Highlighted that appropriate donor choice can enhance GVM activity without significant GVHD risks

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is curative for many patients with high-risk, hematologic malignancies. AlloHCT depends on a graft versus malignancy (GVM) phenomenon, whereby donor-derived immune cells recognize and eradicate malignant host cells. Successful GVM correlates with the risk of alloreactivity against healthy tissues (graft-vs-host disease GVHD). HLA genes are central to immunologic recognition of self and mediate both GVM and GVHD. Historically, HLA-mismatched alloHCT was limited by the high incidence of severe GVHD. This led to a strong preference for HLA-matched donors, limiting access to HCT in patients without an HLA-matched donor. More recent advances in the prevention of GVHD, such as post-transplant cyclophosphamide, resulted in improved outcomes after HLA-mismatched donor HCT. New possibilities now exist to select donors for strategies designed to exploit GVM without significant GVHD. Here, we discuss the practical applications of donor selection to improve the overall efficacy of alloHCT.

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