Is there a best graft source of transplantation in acute myeloid leukemia?

Only 30% of patients in the US who require an allogeneic hematopoietic cell transplant will have a fully HLA matched sibling donor. The National Marrow Donor Program/Be the Match has grown to over 25 million unrelated donors. However, a fully matched unrelated donor may not be available for many patients, particularly for patients of diverse racial and ethnic backgrounds. Over the last 10 years, considerable progress has been made in alternative donor transplant with improvements in outcomes for umbilical cord blood (UCB), haploidentical (haplo) related donor, and mismatched unrelated donor (MMUD) for patients with acute myeloid leukemia. Retrospective studies indicate comparable survival for these three graft sources. In this chapter, we review the latest results for patients receiving alternative donor transplants, and discuss strategies for choosing the optimal donor for each individual patient.