Donor Search and Selection Strategy to Facilitate Comparable Transplant Rates across Donor Search Prognosis Groups: A Report from the BMT CTN 1702 Trial. Transplant Cell Ther 2026 Jun;32(6):678-688
Date
01/18/2026Pubmed ID
41547399Pubmed Central ID
PMC13086071DOI
10.1016/j.jtct.2026.01.014Scopus ID
2-s2.0-105034344999 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
In a secondary analysis from the BMT CTN 1702 trial, we report on donor search and selection strategies according to baseline recipient search prognosis (SP). A total of 1751 patients in 3 SP groups-very likely, 958; less likely, 517; very unlikely, 276- were analyzed. The target time to HCT was most often 6 to 12 weeks (SP P = nonsignificant) and was associated with acute myelogenous leukemia remission status (P < .01). The baseline preferred alternative donor (across all SP groups was most commonly a haploidentical (haplo) donor (62.2% overall), whereas the use of mismatched unrelated donors (MMUDs) increased over time during the study period. Those in the less/very unlikely groups prioritized more alternative donor types at baseline and had more priority ranking changes (SP P < .01). While a comparable number of donors were typed (all SP: median, 3 donors; median time, 1.1 months), less/very unlikely SP had greater use of alternative donors (SP P < .01). Reasons for nonselection of typed donors varied by SP group. For less/very unlikely SP, the rates of HLA mismatching and donor-specific antibodies were higher, while for very likely SP, the use of other preferred donors was more common. Of 1751, 65% reached HCT: 94% of the very likely had an 8/8 matched unrelated donor (MUD) and 91% of the very unlikely had an alternative donor (haplo, 61%; MMUD, 22%; umbilical cord blood, 8%). HCT occurred within the initial desired timeline in 38% of all subjects. HCT delays occurred in 29%, mostly for disease or patient health overall, and of these 52% reached HCT after delay. In this prospective, multicenter evaluation of donor search and selection practices, we demonstrate that patients with poor likelihood of 8/8 MUD matching can reach HCT at comparable rates and with similar effort (time spent typing, number of donors typed) using an early alternative donor-centered strategy. Uniformly across SP groups, the target time to HCT is not commonly reached and is disrupted mostly by disease/patient health delays and not by donor unavailability.
Author List
Pidala J, Logan B, Lee SJ, Shaw BE, Devine S, Ciurea SO, Horowitz M, He N, Pusic I, Srour SA, Arai S, Juckett M, Uberti J, Hill L, Vasu S, Hogan WJ, Hayes-Lattin B, Westervelt P, Bashey A, Farhadfar N, Grunwald MR, Leifer E, Symons H, Saad A, Vogel J, Erickson C, Buck K, Dehn JGAuthor
Bronwen E. Shaw PhD, MD Center Director, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultBone Marrow Transplantation
Donor Selection
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Prognosis
Tissue Donors
Unrelated Donors
