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Current status of haploidentical stem cell transplantation
Author(s) -
Dey Bimalangshu R.,
Spitzer Thomas R.
Publication year - 2006
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2006.06300.x
Subject(s) - stem cell , transplantation , medicine , oncology , immunology , intensive care medicine , biology , genetics
Summary Haploidentical stem cell transplantation is an alternative transplant strategy for patients without an human leucocyte antigen‐matched donor. The historical experience with haploidentical stem cell transplantation has been characterised by the immunological consequences of crossing a major histocompatibility barrier, namely graft‐ versus ‐host disease (GVHD), graft rejection and impaired immune reconstitution. Ex vivo T‐cell depletion of the graft may reduce the risk of GVHD, but at the expense of a higher risk of engraftment failure and relapse of the underlying malignancy. Myeloablative transplant strategies using vigorously T‐cell‐depleted ‘megadose’ stem cells appear to have improved the outcomes of selected patients with acute leukaemia. Non‐myeloablative stem cell transplantation strategies, in which mixed chimaerism as a platform for adoptive cellular immunotherapy is intentionally induced, show promise for limiting GVHD and lessening transplant‐related mortality. Future approaches, based on promising preclinical and early clinical observations, may include selective allodepletion of the graft, and manipulation of the cellular environment post‐transplant using selected cellular populations or immunomodulatory soluble factors.