Hematopoietic stem cell transplant (HSCT) is an important therapeutic option for children with malignant and nonmalignant disease. Over the past 50 years, there has been an increasing number of indications for HSCT. Human leukocyte antigen (HLA) matched related donors offer the best outcome and frequently donors are siblings that are children. Haploidentical and unrelated donors have expanded the pool of donors. Improved HLA typing and posttransplant supportive care has improved the outcome of HSCT from alternative donors. The American Academy of Pediatrics published a statement regarding pediatric patients undergoing HSCT. The policy recommended new standards that had significant impact on both pediatric stem cell transplant physicians and parents. Choosing the appropriate donor depends on the patient and donor’s degree of HLA matching, sex, parity, blood type, CMV status, HLA directed antibodies, and the health of the donor.
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