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Experts' considerations on HLA-haploidentical stem cell transplantation.

Francesca Patriarca1, Leo Luznik, Marta Medeot

  • 1Department of Hematology, Stem Cell Transplant Unit, DISM, University Hospital, Udine, Italy.

European Journal of Haematology
|March 26, 2014
PubMed
Summary

Human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (haploHSCT) is expanding. Experts recommend alternative donors for eligible patients lacking matched donors, prioritizing rapid transplantation and specific donor characteristics.

Keywords:
HLA-haploidentical donorsT-cell depletionallogeneic stem cell transplantationpost-transplantation cyclophosphamide

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Area of Science:

  • Hematology
  • Immunology
  • Transplantation Medicine

Background:

  • Novel strategies have increased the feasibility of human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (haploHSCT).
  • Control of graft-versus-host disease and facilitation of engraftment are key challenges addressed by new approaches.

Purpose of the Study:

  • To review the biological rationale and clinical outcomes of T-cell-depleted (TCD) and T-cell-replete (TCR) haploidentical transplant platforms.
  • To foster consensus among experts on eligibility criteria, donor selection, and transplant platform choice for haploHSCT.

Main Methods:

  • A meeting of leading researchers was convened to discuss HLA-haploidentical transplantation strategies.
  • Experts reviewed existing data and debated critical decision points in haploHSCT.

Main Results:

  • Patients eligible for allogeneic transplant lacking HLA-identical or matched unrelated donors should consider alternative donor haploHSCT.
  • Rapidity of transplantation is crucial to prevent disease relapse/progression when selecting an alternative donor.
  • Donor selection criteria include younger age, ABO compatibility, and Cytomegalovirus status; NK-alloreactive donors or mothers are preferred for TCD transplants.

Conclusions:

  • Consensus was reached on key considerations for haploHSCT, including patient eligibility and donor/platform selection.
  • Prospective studies are necessary to compare the efficacy of different transplant platforms.
  • Expertise in stem cell manipulation and adoptive immunotherapy is vital for TCD haploHSCT approaches.