Related haploidentical donors are a better choice than matched unrelated donors: Point

When a person seeks to purchase a product in the marketplace, be it a car or an apple, 2 product characteristics are decisive: price and quality. If a customer perceives 2 varieties of apples to be of equal quality, then the cheaper variety will be preferred and purchased. For patients who lack an HLA-matched sibling donor, bone marrow transplant physicians often must choose between a well-matched unrelated adult donor (MUD) or an HLA-haploidentical (haplo) relative. In the past, the choice was fairly easy: outcomes after transplantation using MUDs approached those from matched sibling donors 1-3 and both donor types were easily superior to the poor survivals seen using haplo donors. 4 However, haplo transplant outcomes have improved dramatically with modern methods of graft-versus-host disease (GVHD) prophylaxis including the combination of antithymocyte globulin, cyclosporine, methotrexate, and mycophenolate mofetil 5 or high-dose, posttransplantation cyclophosphamide. It is now possible to say that haplo donors are a better choice than MUDs because grafts from haplo donors offer the same or better quality at a lower price than grafts from MUDs.