Abstract
Haploidentical hematopoietic stem-cell transplantation is an alternative transplant strategy for patients without an HLA-matched donor. Still, only half of patients who might benefit from transplantation are able to find an HLA-matched related or unrelated donor. Haploidentical donor is readily available for many patients in need of immediate stem-cell transplantation. Historical experience with haploidentical stem-cell transplantation has been characterised by a high rejection rate, graft-versus-host disease, and transplant-related mortality. Important advances have been made in this field during the last 20 years. Many drawbacks of haploidentical transplants such as graft failure and significant GVHD have been overcome due to the development of new extensive T cell depletion methods with mega dose stem-cell administration. However, prolonged immune deficiency and an increased relapse rate remain unresolved problems of T cell depletion. New approaches such as partial ex vivo or in vivo alloreactive T cell depletion and posttransplant cell therapy will allow to improve immune reconstitution in haploidentical transplants. Results of unmanipulated stem-cell transplantation with using ATG and combined immunosuppression in mismatched/haploidentical transplant setting are promising. This paper focuses on recent advances in haploidentical hematopoietic stem-cell transplantation for hematologic malignancies.
Highlights
Hematopoietic stem-cell transplantation (HSCT) offers a curative treatment for many patients with malignant and nonmalignant hematologic disorders
Posttransplant High-Dose Cyclophosphamide for Selective In Vivo T-Cell Depletion. It has been shown in animal models that both graft rejection and graft-versus-host disease (GVHD) after histoincompatible BMT can be inhibited by the posttransplant administration of high-dose cyclophosphamide, which is known to be highly toxic to lymphocytes proliferating in response to recent antigen stimulation [29]
The first study of haploidentical transplantation from mother to child in advanced leukaemia using busulfan/cyclophosphamide conditioning along with in vivo Tcell depletion with antilymphocyte globulin given before and after unmanipulated bone marrow transplantation was reported by the Pesaro group, Italy, in 1995 [32]
Summary
Hematopoietic stem-cell transplantation (HSCT) offers a curative treatment for many patients with malignant and nonmalignant hematologic disorders. Unrelated cord blood has become a new promising stem-cell source due to its faster availability, tolerance of 1-2 HLA mismatches out of 6, lower incidence and severity of acute graft-versus-host disease (GVHD), and lack of risk to the donor. The initial studies of haploidentical HSCT employed myeloablative conditioning regimen followed by infusion of unmanipulated bone marrow grafts, and GVHD prophylaxis with methotrexate (MTX), with or without cyclosporine (CSA) [6,7,8]. Outcome of these transplants was poor due to high rate of graft failure, severe GVHD, and nonrelapse mortality (NRM), especially when donors were mismatched for 2 or more antigens. This paper focuses on recent developments which have led to more encouraging results in haploidentical HSCT for malignant diseases in adult patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
