Options for People Without a Match
SCCA's Alternative Donor Program offers outstanding outcomes, and provides opportunities for virtually any patient to receive a transplant.
Only 30 percent of transplant patients have matched sibling donors. Half of the remaining 70 percent will find matched unrelated donors leaving 35 percent looking for alternatives.
"For a long time, matched unrelated donors have been the alternative donors of choice,” says Dr. Paul O’Donnell, medical director of the Adult Transplant Service at Seattle Cancer Care Alliance and researcher in the Clinical Research Division at Fred Hutchinson Cancer Research Center. “Our outcomes using such donors consistently outperform other centers. Now we are able to offer those patients who can’t find a matched unrelated donor with the option of transplants using a haploidentical donor or unrelated cord blood.”
Haploidentical means sharing a haplotype; having the same alleles at a set of closely linked genes on one chromosome. The Transplant Program at Seattle Cancer Care Alliance provides all three types of alternative donors and has several well-developed clinical studies available for patients, for full and mini-transplants.
“Many centers across the country are finding that outcomes of transplants using haploidentical or cord blood donors are very similar to matched donors,” O’Donnell says. “The incidences of acute or chronic graft versus host disease are surprisingly less or similar to matched donors using current protocols.”
The key to success of a haploidentical transplant relies on the administration of high-dose cyclophosphamide after the transplant, “which is counter-intuitive,” according to O’Donnell. It’s given on days three and four post-transplant followed on day five with standard immunosuppressive treatments. “The cost of this drug is only about $300 – a wonderfully low-tech approach in our high-tech era,” he says.
For cord blood transplants, SCCA physicians now routinely use a combination of two cord blood units to extend this type of donor option to adult patients, which was formerly restricted to pediatric patients. “New studies in which one of the cord blood units is grown in the lab pre-transplant has been successful in increasing the rate of engraftment post-transplant,” O’Donnell says.