Alternative donor sources in pediatric bone marrow transplantation.

Every year 2,800 children are diagnosed with leukemia and between 30% and 60% will relapse and need a bone marrow transplant. In addition, children with hematologic, genetic, or immunologic diseases may also require a transplant to be cured. Unfortunately, only 30% of these children will have a human leukocyte antigen-matched sibling donor. The current options for alternative donor sources include matched unrelated donor, mismatched related donor, and unrelated cord blood donor. Compared to a matched sibling donor, each of these options has an increased risk for graft failure and graft-versus-host disease (GVHD). For patients who receive stem cells from matched unrelated donors or mismatched related donors, the risk of graft failure is 5% to 10% and the risk of GVHD approaches 80%. After unrelated cord blood transplants, the graft failure rate is 8%, but this is potentially offset by less severe GVHD. Challenges for nurses include providing anticipatory guidance for patients and families undergoing these novel therapies and devising treatment strategies to manage the complications. Graft failure, GVHD, and infections pose the most significant risks associated with alternative donor transplants.