Improving the clinical outcome of unmanipulated haploidentical blood and marrow transplantation

Abstract

Unmanipulated haploidentical blood and marrow transplantation (HBMT) has been one of the most applied haploidentical transplant protocol, which offers rapid immune recovery, desirable health-related quality of life and comparable survival rate with those who received HLA-identical sibling transplantation or HLA-matched unrelated donor transplantation. Compared with HLA-identical sibling recipients, HBMT recipients experienced a lower risk of late effects. The HBMT protocol also shows superior in treating pediatric hematological malignancies compared with umbilical cord blood transplantation and could be successfully used as a post-remission treatment algorithm for adults acute myeloid leukemia with unfavorable cytogenetics. Several approaches, including optimal dose investigation of anti-thymocyte globulin, selecting the best donor, and modified donor lymphocyte infusion, have been designed to improve transplant outcomes.

Depletion of αβ+ T cells for a haploidentical hematopoietic stem cell transplantation in children

“…Acute GVHD remains the main cause of TRM, and chronic GVHD is one of the major factors significantly compromising quality of life of children receiving an allogeneic HCT. Recent advances with effective ex vivo depletion of T cells or unmanipulated in vivo regulation of T cells have significantly improved the outcome of a haploidentical HCT . Establishment of the optimal ex vivo T cell depletion technique to prevent GVHD is an important issue for an HCT from haploidentical relatives.…”

Impact of conditioning intensity on outcomes of haploidentical stem cell transplantation for patients with acute myeloid leukemia 45 years of age and over

“…Haploidentical stem cell transplantation (haplo‐SCT) is a valid and rapidly available therapeutic option for patients with high‐risk acute myeloid leukemia (AML) who do not have an HLA‐identical sibling or unrelated donor . In recent years, most haplo‐SCTs are being performed without T cell depletion (T cell–replete haplo‐SCT) with improving outcomes due to faster immune reconstitution and a lower incidence of nonrelapse mortality (NRM) related to graft‐versus‐host disease (GVHD), graft rejection, and life‐threatening infections . Notably, the results of haplo‐SCT also improved in patients with AML who were ≥60 years of age …”

“…1 In recent years, most haplo-SCTs are being performed without T cell depletion (T cell-replete haplo-SCT) with improving outcomes due to faster immune reconstitution and a lower incidence of nonrelapse mortality (NRM) related to graft-versus-host disease (GVHD), graft rejection, and life-threatening infections. 2,3 Notably, the results of haplo-SCT also improved in patients with AML who were ≥60 years of age. 4,5 The optimal conditioning intensity regimen for allogeneic transplantation for patients with AML is a debated topic.…”

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“…Development of appropriate multilineage therapeutic measures for HLA sensitized patients, especially the use of ATG, has also gone a long way in preventing this dreaded complication which is usually associated with a substantial mortality rate. With the advent of these recent advances the graft failure rate in haploidentical transplantation has decreased to less than 5% [8,9].…”