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Review
. 2015 Jun;50 Suppl 2(0 2):S31-6.
doi: 10.1038/bmt.2015.92.

HLA-haploidentical blood or marrow transplantation with high-dose, post-transplantation cyclophosphamide

E J Fuchs  1
Affiliations
Review

HLA-haploidentical blood or marrow transplantation with high-dose, post-transplantation cyclophosphamide

E J Fuchs. Bone Marrow Transplant. 2015 Jun.

Abstract

In the past, partially HLA-mismatched related donor, or HLA-haploidentical, blood or marrow transplantation (haploBMT), for hematologic malignancies has been complicated by unacceptably high incidences of graft rejection or GvHD resulting from intense bi-directional alloreactivity. Administration of high doses of cyclophosphamide early after haploBMT selectively kills proliferating, alloreactive T cells while sparing non-alloreactive T cells responsible for immune reconstitution and resistance to infection. In the clinic, haploBMT with high-dose, post-transplantation cyclophosphamide is associated with acceptably low incidences of fatal graft rejection, GvHD and non-relapse mortality, and provides an acceptable treatment option for hematologic malignancies patients lacking suitably HLA-matched donors. HaploBMT with PTCy is now being investigated as a treatment of hemoglobinopathy and as a method for inducing tolerance to solid organs transplanted from the same donor. Ongoing and future clinical trials will establish the hierarchy of donor preference for hematologic malignancy patients lacking an HLA-matched sibling.

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Conflict of interest statement

CONFLICT OF INTEREST

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Treatment schema for nonmyeloablative, HLA-haploidentical bone marrow transplantation (haploBMT) with high-dose, posttransplantation cyclophosphamide (PTCy). Cy = cyclophosphamide; MMF = mycophenolate mofetil.
Figure 2
Figure 2
Major outcomes of non-myeloablative, haploBMT with PTCy. OS = overall survival.
Figure 3
Figure 3
Survival after nonmyeloablative, haploBMT with PTCy, by tumor histology. NHL = non-Hodgkin lymphoma.
Figure 4
Figure 4
Non-relapse mortality (left) and PFS (right) after nonmyeloablative haploBMT with PTCy, by patient age (decades).
Figure 5
Figure 5
Treatment schema for nonmyeloablative, haploBMT with PTCy for patients with sickle cell disease. BMT = bone marrow transplantation; BM = bone marrow; Cy = cyclophosphamide; MMF = mycophenolate mofetil.
See this image and copyright information in PMC

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