Haploidentical Hematopoietic Cell Transplantation

Published on 04/03/2015 by admin

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Last modified 04/03/2015

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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

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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