Haploidentical hematopoietic stem cell transplantation with unmanipulated granulocyte colony stimulating factor mobilized marrow and blood grafts

Abstract

Purpose of review: This article summarizes recent improvements and progress with unmanipulated haploidentical blood and marrow transplantation (HBMT) and discusses the difference in outcomes between patients receiving HBMT and those receiving unmanipulated granulocyte colony stimulating factor (G-CSF) mobilized haploidentical peripheral blood (G-PB) grafts as allografts.

Recent findings: Long-term follow-up confirmed that unmanipulated HBMT is a promising protocol that can be successfully extended to treat severe aplastic anemia. Recent observations regarding immune recovery, infections, and strategy for modified donor lymphocyte infusions have provided insight into the prevention of infections and the decrease in relapse after HBMT. Extensive chronic graft-versus-host disease (GVHD) strongly and negatively impacts patient health-related quality of life, suggesting that it should be successfully controlled. A prospective study suggested the inclusion of HBMT in treatment algorithms as a viable option for adults with acute myeloid leukemia with unfavorable cytogenetics who lack a matched donor. Randomized clinical trials are warranted to investigate whether mixture grafts of G-CSF-mobilized blood and marrow or G-PB alone should be chosen as allografts in haploidentical settings.

Summary: Unmanipulated HBMT is a reliable protocol. New strategies should be investigated to decrease the incidences of GVHD and relapse. Novel mobilization regimens such as AMD3100 alone or G-CSF+AMD3100 for allograft engineering may improve transplant outcomes following HBMT.