New Guidelines Shift Donor Selection for Patients With Blood Cancer

Advancements across the landscape of transplant medicine have prompted updates in how doctors choose donors for allogeneic hematopoietic cell transplants (also known as HCT); this is a potentially life-saving treatment for many patients with blood cancers and hematologic disorders.

Dr. Antonio M. Jimenez-Jimenez — a lead investigator who helped pioneer research into these updates — sat down for an interview with CURE to discuss the impact of these updates on patient cancer care. In the interview, he highlighted how these changes represent a major shift in care towards a more personalized donor selection, which increase the chances of finding a suitable match.

Jimenez leads the Mismatched Allogeneic Transplant Program at the University of Miami Health System, Sylvester Comprehensive Cancer Center. He is also an associate professor of Clinical Medicine in the Department of Medicine, Division of Transplantation and Cellular Therapy at the University of Miami Miller School of Medicine.

Transcript

What were some of the key motivators behind updating the donor selection guidelines at this time?

The main thing was that there was a need in our community to update the guidelines to adapt them to the current landscape of donor selection. I think there were two main things. Number one, our field has evolved very rapidly, especially with the success of cyclophosphamide post-transplant in reducing graft-versus-host disease across a range of donor types. This really challenged the old model we used to have where only fully matched donors were used or preferred.

The second thing is that we have much better data now, like data from a large study shows that when we use a more individualized donor search based on a patient's ancestry and HLA type, we can improve both the access and the timeliness of a transplant. So, we felt this was the right time to consolidate all that evidence into more clear, modern, and practical guidance. We now recommend searching for all donor types concurrently rather than moving step-by-step through a matched sibling donor, a matched unrelated donor, and then alternative donors.

Another big one is the emphasis we are making on donor age. We now prioritize donors who are younger than 30, regardless of donor type, because we have seen that this is consistently associated with better survival.

I think a third thing is that we became a little bit more permissive with HLA mismatch in the right setting, of course, especially when we use some of the newer GVHD prevention treatments. So now we have a little bit more flexibility in donor choice compared to the past guidelines.

Transcript has been edited for clarity and conciseness

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.