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Allogeneic Hematopoietic Stem Cell Transplant Using Mismatched/Haploidentical Donors

Koh, Liang-Piu ; Rizzieri, David A ; Chao, Nelson J

Biology of blood and marrow transplantation, 2007-11, Vol.13 (11), p.1249-1267

United States: Elsevier Inc

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  • Título:
    Allogeneic Hematopoietic Stem Cell Transplant Using Mismatched/Haploidentical Donors
  • Autor: Koh, Liang-Piu ; Rizzieri, David A ; Chao, Nelson J
  • Assuntos: Graft Survival - immunology ; GVHD ; Haplotypes ; Hematology, Oncology and Palliative Medicine ; Hematopoietic Stem Cell Transplantation - methods ; HLA Antigens - immunology ; Humans ; Immune reconstruction ; Lymphocyte Depletion - methods ; T cell depletion ; Transplantation Conditioning - methods ; Transplantation Tolerance - immunology ; Transplantation, Homologous - immunology
  • É parte de: Biology of blood and marrow transplantation, 2007-11, Vol.13 (11), p.1249-1267
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-3
    content type line 23
    ObjectType-Review-1
  • Descrição: Abstract Haploidentical hematopoietic stem cell transplantation (HSCT) provides an opportunity for nearly all patients to benefit from HSCT when a human leukocyte antigen (HLA) genotypically matched sibling is not available. Initial results with the use of mismatched allografts led to limited enthusiasm because of graft-versus-host disease (GVHD) and infectious complications, resulting in an unacceptable treatment-related morbidity and mortality. Recent advances with effective T cell depletion, the use of a “megadose” of stem cells, earlier detection of severe infections, combined with better antimicrobial therapy and reduced-intensity conditioning (RIC) has significantly decreased the early transplant-related mortality and GVHD, whereas enabling prompt engraftment, hence advancing the therapeutic benefit of haploidentical transplantation. However, the cardinal problems related to delayed immune reconstitution allowing posttransplant infectious complications and relapse remain, limiting the efficacy of haploidentical HSCT. Preliminary data has demonstrated the potential for use of adoptive cellular immunity and selective allodepletion in rapidly reconstituting immunity without GVHD. The encouraging reports from haploidentical transplant using noninherited maternal antigen (NIMA)-mismatched or natural killer (NK) alloreactive donors may greatly increase the donor availability and open the way to more appropriate donor selection in HLA-haploidentical HSCT. Future challenges remain in determining the safest approach for haploidentical transplant to be performed with minimal risk of GVHD, whereas preserving effective graft-versus-leukemia activity and promoting prompt immune reconstitution.
  • Editor: United States: Elsevier Inc
  • Idioma: Inglês
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