Haploidentical hematopoietic stem cell transplant: How to choose the best donor? Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

Haploidentical hemotopoietic stem cell transplantation hos been growing steadily since 2012. The SFGM-TC has twice published guidelines concerning T-cell repleted haploidentical grafts with high dose cyclophosphomide post-transplantation. The 2013 workshop recommended using the non-myeloablative Baltimore protocol with bone morrow and developed prospective protocols to evaluate these transplantations. The 2015 workshop reported improved results of reduced conditioning regimens in Hodgkin's lymphoma and intensive conditioning in myeloid hemopathies, and a similar outcome with 10/10 HIA matched donor with the same disease-risk score thus raising the question of the qualifier alternative for haploidentical transplants. The current work concerns the criteria for selecting the donor. The main criterion remains the absence of anti-HLA antibodies directed against the donor present in the recipient sera (DSA - Donor Specific Antibodies). In case of DSA and in the absence of on alternative donor, desensitization protocols exist. The other criteria ore impossible to prioritize: age, sex, CMV, and blood type. The degree of relatedness and the number of MA incompatibilities do not seem to be a criterion of choice. The 'ideal' donor would be a young mon, CMV-matched, without major ABO incompatibility with a marrow transplant. There is insufficient data for the KIR-ligand and NIMA/NIPA mismatch. Peripheral stem cell grofts appear to yield more acute GVHD thon bone marrow grofts after intensive conditioning, but with comparable survival rates. Based on the literature review, the comparison of haploidentical with unrelated donors encourages inclusion in existing national protocols randomizing these different donors.