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[126,127][Level of evidence C1] Another CIBMTR study suggested that outcome after one- or two-antigen mismatched cord blood transplants may be equivalent to that for a matched family donor or a matched unrelated donor.[128] In certain cases in which no suitable donor is found or an immediate transplant is considered crucial, a haploidentical transplant using large doses of stem cells may be considered.[129,130] Improved approaches to haploidentical HSCT using alpha-beta T-cell receptor (TCR)/CD19 depletion or posttransplant cyclophosphamide have shown survival rates that are similar to those in studies using other stem cell sources.[131] A large multicenter trial from Italy showed similar outcomes using alpha-beta TCR/CD19depleted haploidentical donors compared with matched unrelated donors, with lower rates of GVHD.[132] A second multicenter trial using alpha-beta TCR/CD19depleted killer immunoglobulin-like receptor (KIR)favorable haploidentical donors showed survival outcomes comparable to all other stem cell sources, with lower rates of GVHD and transplant-related mortality.[133] Role of GVHD/GVL in ALL and immune modulation after transplant to prevent relapse Most studies of pediatric and young adult patients that address this issue suggest an effect of both acute and chronic GVHD in decreasing relapse.[115,134-137] In a COG trial of transplant for children with ALL, grades I to III acute GVHD were associated with lower relapse risk (HR, 0.4

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