Advances in haploidentical stem cell transplantation

Abstract

Hematopoietic stem cell transplantation from haploidentical donors is an attractive method of transplantation due to the immediate donor availability, ease of stem cell procurement and the possibility to collect additional donor cells for cellular therapy, if needed. Historically, maintaining T-cells in the graft has been associated with very high rates of graft-versus-host disease, while T-cell depleted haploidentical transplantation has been limited by a higher incidence of graft rejection and delayed immune reconstitution post-transplant. Recent approaches attempt to maintain the T-cells in the graft while effectively preventing the development of graft-versus-host disease post-transplant. Selective depletion of alloreactive T-cells post-transplant using high-dose post-transplant cyclophosphamide is under investigation as a promising alternative in haploidentical transplantation. While engraftment has improved and graft-versus-host disease is controlled with this approach, future directions should focus on optimizing conditioning regimens and the prevention of disease relapse post-transplant.

Antigen and Lymphopenia-Driven Donor T Cells Are Differentially Diminished by Post-Transplantation Administration of Cyclophosphamide after Hematopoietic Cell Transplantation

“…Recently, clinical trials have been performed at several centers to begin assessing the efficacy of post-transplant cyclophosphamide (PTC) administration to ameliorate GVHD [23–25]. http://clinicaltrials.gov/show/NCT01427881.…”

T Cell Depleted Haploidentical Hematopoietic Stem Cell Transplantation for Patients with Familial Hemophagocytic Lymphohistiocytosis Who Do Not Have Matched Family Donors: Experience in Oman

“…A conditioning regimen of fludarabine, melphalan, or treosulfan and alemtuzumab achieved less transplant-related mortality and improved the survival rate from 43% with MAC (busulfan/ cyclophosphamide/etoposide (VePesid) § ATG) to an estimated 3-year median survival rate of 92% with RIC [8,9]. Initial reports on haploidentical transplants were complicated by engraftment failure and a high incidence of GVHD and infectious complications [10]. In the early 1990s, the HLH international registry reported 10 patients who received a haploidentical familial transplant, with 2 survivors only [11].…”

Research contributions for the Nursing care in pediatric transplantation of hematopoietic stem cells / Contribuições da pesquisa para os cuidados de Enfermagem em transplante pediátrico de células-tronco hematopoiéticas

“…In this type of transplantation conditioning and immunological prophylaxis are differentiated and may be more aggressive, with extensive prevention of GVHD. 10 Recalling that HLA incompatibilities are related to delayed immune reconstitution and increased risk of GVHD and rejection of grafted cells. 11 Hence, by receiving a more aggressive pre-HSCT preparation to prevent rejection, the adverse effects of treatment may be potentiated, compromising the recovery after the HSCT.…”