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2015 ; 29
(2
): 63-70
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"No donor"? Consider a haploidentical transplant
#MMPMID25307958
Ciurea SO
; Bayraktar UD
Blood Rev
2015[Mar]; 29
(2
): 63-70
PMID25307958
show ga
Haploidentical stem cell transplantation (HaploSCT) is an attractive option for
patients requiring a hematopoietic stem cell transplant who do not have an
HLA-matched donor, because it is cheaper, can be performed faster, and may extend
transplantation to virtually all patients in need. Significant advances have been
made in the recent decade with dramatic improvement in treatment outcomes.
Historically, overcoming the HLA-incompatibility barrier has been a significant
limitation to the expansion of this form of transplant. While ex vivo T-cell
depletion effectively prevented the development of acute GVHD, it was associated
with a higher treatment-related mortality, in excess of 40% in some series, due
to a significant delay in recovery of the adaptive immune system. Newer methods
have successfully maintained the memory T cells in the graft and/or selectively
depleted alloreactive T cells, and are associated with improved treatment
outcomes. Post-transplant cyclophosphamide for GVHD prevention has proven very
effective in controlling GVHD with lower incidence of infectious complications
and treatment-related mortality-as low as 7% at 1 year-and has become the new
standard in how this transplant is performed. Here, we reviewed the current
experience with this approach and various other strategies employed to control
alloreactivity in this setting, including selective depletion of T cells from the
graft, as well as we discuss post-transplantation therapy to prevent disease
relapse and improve immunologic reconstitution.
|Animals
[MESH]
|Cell Engineering/methods
[MESH]
|Cell- and Tissue-Based Therapy/methods
[MESH]
|Cyclophosphamide/therapeutic use
[MESH]
|Graft vs Host Disease/etiology/immunology/prevention & control/*therapy
[MESH]
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