Haploidentical Hematopoietic Cell Transplantation

Chapter 48 Haploidentical Hematopoietic Cell Transplantation



Bimalangshu R. Dey, Thomas R. Spitzer



Haploidentical Hematopoietic Cell Transplantation: Why Bother?


Haploidentical hematopoietic cell transplantation (HCT) involves related donor-recipient combinations sharing one haplotype who are mismatched for one to three human leukocyte antigens (HLA) on the other haplotype



• Only 30% of patients have an HLA genotypically or phenotypically matched related donor


• Successful haploidentical HCT would mean that most patients would have an immediately available donor


• A more potent graft-versus-tumor (GVT) effect may occur following histoincompatible HCT



Myeloablative Haploidentical HCT: Survival Outcomes—Conclusions in 1985




• Equivalent following HLA-matched and single HLA antigen–mismatched related HCT


• Inferior following two to three HLA antigen–mismatched HCT



Myeloablative Haploidentical HCT: Conclusions in 1997




• For favorable-risk hematologic malignancies


Haploidentical HCT is associated with inferior survival outcomes

• For intermediate- to high-risk hematologic malignancies


Single HLA antigen–mismatched related transplant equals matched unrelated-donor transplant

• For intermediate- to high-risk hematologic malignancies


Two HLA antigen–mismatched related transplant equals single HLA antigen–mismatched unrelated donor transplant


Haploidentical HCT: Conclusions in 2011


Haploidentical HCT is feasible in selected circumstances in which matched donors are unavailable. However, the following problems remain:



• It is unclear whether a stronger graft-versus-leukemia effect occurs


• Graft-versus-host disease (GVHD) and graft rejection are problematic, although becoming more manageable with vigorous T-cell depletion (TCD) and high stem cell dose


• Immune reconstitution, particularly following TCD, is poor



Nonmyeloablative Haploidentical HCT: Rationale


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Jun 12, 2016 | Posted by in HEMATOLOGY | Comments Off on Haploidentical Hematopoietic Cell Transplantation

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