Nonmyeloablative allogeneic hematopoietic stem cell transplant using mismatched/haploidentical donors: a review.

Published

Journal Article (Review)

Haploidentical hematopoietic stem cell transplantation (HSCT) provides an opportunity for patients to benefit from HCT when a human leukocyte antigen (HLA) genotypically matched sibling is not available. Initial results with the use of mismatched allograft has been disappointing due to the high incidence 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 'megadose' of stem cells and reduced intensity conditioning has significantly decreased the early transplant related mortality and GvHD, while enabling robust and prompt engraftment, and hence enhancing the therapeutic benefits of haploidentical transplantation. However, the cardinal problems related to delayed immune reconstitution causing posttransplant infectious complications and relapse remain, limiting the efficacy of haploidentical transplant. Preliminary data have demonstrated the great potential in the 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 donors or natural killer alloreactive donors may greatly increase the donor availability and open a 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, while preserving effective graft-versus-leukemia activity and promoting prompt immune reconstitution.

Full Text

Duke Authors

Cited Authors

  • Koh, L-P; Chao, NJ

Published Date

  • January 2008

Published In

Volume / Issue

  • 40 / 1

Start / End Page

  • 20 - 24

PubMed ID

  • 17884641

Pubmed Central ID

  • 17884641

International Standard Serial Number (ISSN)

  • 1079-9796

Digital Object Identifier (DOI)

  • 10.1016/j.bcmd.2007.06.017

Language

  • eng

Conference Location

  • United States