Haploidentical Stem Cell Transplantation in Adult Haematological Malignancies

Abstract

Haematopoietic stem cell transplantation is a well-established treatment option for both hematological malignancies and nonmalignant conditions such as aplastic anemia and haemoglobinopathies. For those patients lacking a suitable matched sibling or matched unrelated donor, haploidentical donors are an alternative expedient donor pool. Historically, haploidentical transplantation led to high rates of graft rejection and GVHD. Strategies to circumvent these issues include T cell depletion and management of complications thereof or T replete transplants with GVHD prophylaxis. This review is an overview of these strategies and contemporaneous outcomes for hematological malignancies in adult haploidentical stem cell transplant recipients.

Immune tolerance induction by nonmyeloablative haploidentical HSCT combining T-cell depletion and posttransplant cyclophosphamide

“…Thus, transplantation of HSCT following an NMAC regimen has been largely limited over the past 2 decades to T-cell-replete transplants, attaining engraftment by virtue of the large number of donor alloreactive T cells at the expense of the substantial risk of acute and chronic GVHD, even with extensive posttransplant GVHD prophylaxis. [3][4][5] As described above, the use of high-dose PTCY has reduced the risk of GVHD, but not enough to justify such transplants as a platform for organ transplantation or in the treatment of nonmalignant diseases 1,[6][7][8][9] or highrisk hematological malignancies in which posttransplant immune suppression can adversely impact antitumor immunity. On the other hand, attaining engraftment following TCD bone marrow (BM) transplants, especially in haploidentical patients conditioned with a nonmyeloablative regimen, still represents a major challenge.…”

High ocular CMV copies and mismatched receipts may predict poor visual prognosis in CMV retinitis patients following allogeneic haematopoietic stem cell transplantation

“…Fortunately, the broadening of HSCT indication brings opportunity of survival and hope to these patients whose donors are only partially HLA-matched. Some studies have outlined the positive impact of HSCT from HLA-mismatched donors on overall survival, while also noted its high rate of complications [ 6 ]. In our study, 8 eyes were diagnosed as CMV retinitis in theses 5 HLA-mismatched receipts.…”

“…CMV retinitis after allogeneic haematopoietic stem cell transplantation (HSCT) has been concerned with the increment of HSCT recipients [ 6 , 7 ]. HSCT is a well established treatment for many hematological diseases such as acute leukaemia, myelodysplastic syndromes and aplastic anemia.…”

“…The donor for HSCT was initially limited to an identical twin, and then extended to human leucocyte antigen (HLA)-matched related or unrelated donor. Later, HSCT from a HLA-mismatched donor was also used in some patients lacking suitable HLA-matched donors [ 6 ]. The rapid progress of HSCT has significantly lowered the rates of transplant-related morbidity and mortality.…”

Regulatory T cells and CD20+B cells in pediatric very severe aplastic anemia: possible clinical markers for evaluating the therapeutic efficacy and prognosis

“…Severe aplastic anemia (SAA) is a refractory disease caused by an immune attack against hematopoietic stem and progenitor cells. This attack results in bone marrow failure characterized by signs of hypoplasia, pancytopenia and fatty bone marrow [1,2]. SAA in childhood remains life-threatening.…”