Update on current research into haploidentical hematopoietic stem cell transplantation

Abstract

Haploidentical stem cell transplantation (Haplo-SCT) is currently a suitable alternative worldwide for patients with hematological diseases, who lack human leukocyte antigen (HLA)-matched siblings or unrelated donors. Areas covered: This review summarizes the advancements in Haplo-SCT in recent years, primarily focusing on the global trends of haploidentical allograft, the comparison of outcomes between Haplo-SCT and other transplantation modalities, strategies for improving clinical outcomes, including donor selection, hematopoietic reconstitution promotion, and graft-versus-host disease, and relapse prevention/management, as well as the expanded indications of Haplo-SCT, such as severe aplastic anemia, myeloma and lymphoma. Expert commentary: Haploidentical allografts, including granulocyte colony-stimulating factor-based protocol and a post-transplant cyclophosphamide-based protocol, have been the mainstream strategy for Haplo-SCT. However, there are many unanswered questions in this field.

A prognostic model (BATAP) with external validation for patients with transplant-associated thrombotic microangiopathy

“…A majority of our study patients underwent ATG-based unmanipulated stem cell transplantation through our established protocol 34 , which has been previously reviewed and is increasingly used worldwide. [31][32][33]35,36 Notably, the transplant protocols may be associated with the risk and outcome of TA-TMA. HLA disparity, conditioning regimens and CNI exposure were well documented as potential risk factors 9,22,45 , whereas recent studies report divergent evidence regarding the prognostic role of donor type 9,21,45 , conditioning and immunosuppressive regimens 3 in patients with TA-TMA.…”

“…Haploidentical stem cell transplantation is currently a suitable alternative for human leukocyte antigen (HLA) matched sibling donor transplantation. 31,32 In this study, a majority of patients received allografts from HLA-partially matched related donors. These patients underwent antihuman thymocyte immunoglobulin (ATG)-based haploidentical stem cell transplantation through our previously established protocol [31][32][33] , which features the combination of peripheral blood stem cell harvests and bone marrow harvests, ATG-based conditioning, and GVHD prophylaxis through cyclosporine a (CsA), methotrexate (MTX) and mycophenolate.…”

“…31,32 In this study, a majority of patients received allografts from HLA-partially matched related donors. These patients underwent antihuman thymocyte immunoglobulin (ATG)-based haploidentical stem cell transplantation through our previously established protocol [31][32][33] , which features the combination of peripheral blood stem cell harvests and bone marrow harvests, ATG-based conditioning, and GVHD prophylaxis through cyclosporine a (CsA), methotrexate (MTX) and mycophenolate. [34][35][36][37][38] In our study, most of the HLA-partially matched recipients received a busulfan (BU)/cyclophosphamide (CY) + ATG regimen for myeloablative conditioning.…”

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

“… 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.…”

Donor selection for haploidentical hematopoietic cell transplantation‐ practice guidance

“…These findings have led to a rapid increase in haplo‐HCT worldwide, accompanied by major advancements in the field. There are currently three major approaches for haplo‐HCT: (1) haplo‐HCT using the Beijing protocol, which is mainly based on granulocyte colony‐stimulating factor (G‐CSF)‐induced immune tolerance; (2) haplo‐HCT based on posttransplant cyclophosphamide (PTCy); and (3) haplo‐HCT with in vitro T‐cell depletion (TCD) . All three of these protocols have advantages and disadvantages.…”