Evolution of the role of haploidentical stem cell transplantation: past, present, and future

Kwon, Mi; Bailén, Rebeca; Díez-Martín, José Luís

doi:10.1080/17474086.2020.1796621

Cited by 19 publications

(16 citation statements)

References 171 publications

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“…Uma explicação para esses valores pode ser a falta de experiência das equipes de TCTH brasileiras em trabalhar com essa técnica. Ademais, na última década ocorreram avanços expressivos no tratamento por meio da utilização de doadores haploidênticos (quando a compatibilidade é parcial), os quais apresentaram altas taxas de sucesso 23,24 . Dessa forma, é provável que equipes que transplantavam pela técnica do cordão umbilical passaram a recorrer mais a essa nova técnica.…”

Section: Resultsunclassified

Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020

Magedanz

Leal

Santos

et al. 2022

Ciênc. saúde coletiva

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Resumo O objetivo deste artigo é descrever a distribuição de Centros Transplantadores (CTs) e transplantes de células-tronco hematopoiéticas (TCTH) no território brasileiro. Estudo descritivo, que reúne informações sobre a distribuição CTs e o número de procedimentos realizados entre 2001 e 2020, a partir das fontes dos dados: Sociedade Brasileira de Terapia celular e Transplantes de Medula Óssea (SBTMO); Associação Brasileira de Transplante de Órgãos (ABTO); Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); e Ministério da Saúde (MS). Foram identificados 86 CTs, com predominância na região Sudeste do país (64%). A região Norte não possui CTs. No período contabilizaram-se mais de 30 mil procedimentos, concentrados nas regiões Sudeste e Sul. O TCTH do tipo alogênico foi prevalente. Constataram-se divergências entre os números de transplantes realizados a depender da fonte consultada. Apesar do crescimento do número de procedimentos no período do estudo, tanto a distribuição de CTs quanto o número de TCTHs se concentrou em regiões mais desenvolvidas. Essa heterogeneidade pode ter propiciado iniquidades no acesso ao tratamento pela população.

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Section: Resultsunclassified

Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020

Magedanz

Leal

Santos

et al. 2022

Ciênc. saúde coletiva

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“…The development and improvement of strategies that allowed the extended use of haploidentical HSCT has increased the pool of patients in need of an allogeneic HSCT that can benefit from this procedure ( 25 , 26 ). However, the higher incidence of GF in haplo-HSCT compared to HLA-identical transplants due to the high degree of mismatch is still a challenge in some of these platforms ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Management of Donor-Specific Antibodies in Haploidentical Transplant: Multicenter Experience From the Madrid Group of Hematopoietic Transplant

et al. 2021

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BackgroundDonor specific antibodies (DSAs) can be responsible for graft failure (GF) in the setting of mismatched hematopoietic stem cell transplantation (HSCT). The aim of our study is to report the experience of the Madrid Group of Hematopoietic Transplant (GMTH) in patients with DSAs undergoing haplo-HSCT.MethodsPatients undergoing haplo-HSCT in centers from the GMTH from 2012 to 2020 were included in the study. DSAs were analyzed with a solid-phase single-antigen immunoassay; monitoring was performed during desensitization on days -14, -7, 0 and in a weekly basis until neutrophil engraftment. Desensitization strategies varied depending on center experience, immunofluorescence intensity, complement fixation and type of antibodies.ResultsWe identified a total of 20 haplo-HSCT in 19 patients performed with DSAs in 5 centers. 10 (53%) patients presented anti-HLA class I DSAs (6 of them with > 5000 mean fluorescence intensity (MFI)), 4 (21%) presented anti-HLA class II (1 with > 5000 MFI) and 5 (26%) presented both anti-HLA class I and II (5 with > 5000 MFI). 90% of patients received at least two treatments as desensitization strategy and all experienced a decrease of MFI after desensitization (mean reduction 74%). Only one patient who developed progressive increase of MFI after infusion developed GF. Desensitization treatments used included rituximab, immunoglobulins, therapeutic plasma exchange, incompatible platelets, buffy coat and immunosuppressors. Seventeen (90%) patients achieved neutrophil engraftment; one patient died before engraftment because of infection and one patient with class I DSAs developed primary GF despite an intensive desensitization. After a median follow-up of 10 months, OS and EFS were 60% and 58%, respectively, cumulative incidence of relapse was 5% and NRM was 32%.ConclusionsDespite the optimal strategy of DSAs desensitization remains unclear, the use of desensitization treatment guided by DSAs intensity kinetics constitute an effective approach with high rates of engraftment for patients with DSAs in need for an haplo-HSCT lacking an alternative suitable donor.

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“… Adapted from “Evolution of the Role of Haploidentical ´ Stem Cell Transplantation: Past, Present, and Future”, Kwon et al ( 7 ) and “Update on Current Research Into Haploidentical Hematopoietic Stem Cell Transplantation”, Sun et al ( 15 ). aGVHD, acute GVHD; AML, acute myeloid leukemia; ATG, anti-thymoglobulin; BM, bone marrow; cGVHD, chronic GVHD; CR(#), complete remission (number #); CsA, ciclosporin-A; DFS, disease-free survival; G-CSF, granulocyte colony-stimulating factor; GVL: graft versus leukemia; IS, immunosuppression; MMF, mycophenolate mofetil; MTX, methotrexate; NRM, non-relapse mortality; OS, overall survival; PBSC, peripheral blood stem cell; PFS, progression-free survival; PT-Cy, post-transplant cyclophosphamide; TCD, T-cell depleted; TCR, T-cell replete; TRM, transplant-related mortality; NMAC, non myeloablative conditioning; #y, # years.…”

Section: Paradigm Shift In Donor Availability and Donor Selectionmentioning

confidence: 99%

Section: Paradigm Shift In Donor Availability and Donor Selectionmentioning

confidence: 99%

“…The likelihood of finding a matched unrelated donor (MUD) depends on the ethnicity and is much higher for whites of European descent than minorities such as blacks of South or Central American descent, 75% vs. 16% respectively, according to US registries ( 5 , 6 ). Moreover, MUDs are only available within a median time of 2–3 months from the start of the donor search, a delay that might be too long for patients requiring aHSCT for high-risk hematological malignancies ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

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KIR in Allogeneic Hematopoietic Stem Cell Transplantation: Need for a Unified Paradigm for Donor Selection

Dhuyser

Aarnink

Pérès³

et al. 2022

Front. Immunol.

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Allogeneic hematopoietic stem cell transplantation (aHSCT) is a lifesaving therapy for hematological malignancies. For years, a fully matched HLA donor was a requisite for the procedure. However, new immunosuppressive strategies have enabled the recruitment of viable alternative donors, particularly haploidentical donors. Over 95% of patients have at least two potential haploidentical donors available to them. To identify the best haploidentical donor, the assessment of new immunogenetic criteria could help. To this end, the clinical benefit of KIR genotyping in aHSCT has been widely studied but remains contentious. This review aims to evaluate the importance of KIR-driven NK cell alloreactivity in the context of aHSCT and explain potential reasons for the discrepancies in the literature. Here, through a non-systematic review, we highlight how the studies in this field and their respective predictive models or scoring strategies could be conceptually opposed, explaining why the role of NK cells remains unclear in aHCST outcomes. We evaluate the limitations of each published prediction model and describe how every scoring strategy to date only partly delivers the requirements for optimally effective NK cells in aHSCT. Finally, we propose approaches toward finding the optimal use of KIR genotyping in aHSCT for a unified criterion for donor selection.

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Evolution of the role of haploidentical stem cell transplantation: past, present, and future

Cited by 19 publications

References 171 publications

Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020

Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020

Management of Donor-Specific Antibodies in Haploidentical Transplant: Multicenter Experience From the Madrid Group of Hematopoietic Transplant

KIR in Allogeneic Hematopoietic Stem Cell Transplantation: Need for a Unified Paradigm for Donor Selection

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