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Review
. 2010 Jan;16(1 Suppl):S57-63.
doi: 10.1016/j.bbmt.2009.10.032. Epub 2009 Nov 3.

HLA-haploidentical stem cell transplantation for hematologic malignancies

Ephraim J Fuchs  1 , Xiao-jun Huang, Jeffrey S Miller
Affiliations
Review

HLA-haploidentical stem cell transplantation for hematologic malignancies

Ephraim J Fuchs et al. Biol Blood Marrow Transplant. 2010 Jan.

Abstract

Partially HLA-mismatched related, or HLA-haploidentical, donor stem cell transplantation (SCT) is a feasible therapeutic option for advanced hematologic malignancies patients who lack an HLA-matched related or unrelated donor. Advances in conditioning regimens, graft manipulation, and pharmacologic prophylaxis of graft-versus-host disease (GVHD) have reduced the risk of fatal graft failure and severe GVHD, two of the most serious complications of traversing the HLA barrier. Clinical observations reveal a potential role for natural killer (NK) cell alloreactivity in reducing the risk of relapse of acute myeloid leukemia after HLA-haploidentical SCT. NK cell infusions attempt to harness the graft-versus-leukemia effect without producing GVHD. The availability of multiple potential HLA-haploidentical related donors for most patients opens the possibility of optimizing transplantation outcome through intelligent donor selection.

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Figures

Figure 1
Figure 1
Treatment schema for nonmyeloablative conditioning and HLA-haploidentical bone marrow transplantation. From ref. .
Figure 2
Figure 2
Effect of HLA-DRB1 antigen mismatch (a,c) or HLA Class I allele mismatches (b,d) in the graft-versus-host direction on relapse, non-relapse mortality (a,b) and event-free survival (c,d) after nonmyeloablative, HLA-haploidentical bone marrow transplantation with high-dose, post-transplantation cyclophosphamide.
Figure 3
Figure 3
The myeloablative conditioning regimen for HLA-haploidentical HSCT at Peking University. Ara-C: cytosine arabinoside; Bu: busulfan; CY: cyclophosphamide; MeCCNU: simustine; ATG: Thymoglobulin.
See this image and copyright information in PMC

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