How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Human Leukocyte Antigen (HLA)-haploidentical hematopoietic stem cell transplantation (HSCT) is a widely adopted alternative donor stem cell source.
• T-cell-replete strategies, particularly those utilizing high-dose posttransplant cyclophosphamide, are prevalent.
• This method offers advantages including no need for graft manipulation or storage, leading to reduced acquisition costs.

Observation:

• Posttransplant cyclophosphamide-based HLA-haploidentical HSCT is linked to reduced rates of severe graft-versus-host disease and nonrelapse mortality.
• This transplantation strategy has shown remarkable safety in older patients (up to 75 years) using reduced-intensity conditioning.
• Outcomes in older patients are comparable to those in younger patient cohorts.

Findings:

• Large retrospective studies confirm the efficacy of HLA-haploidentical HSCT with posttransplant cyclophosphamide.
• Results are comparable to those achieved with HLA-matched HSCT.
• This approach provides a rapidly available and clinically straightforward platform for stem cell transplantation.

Implications:

• HLA-haploidentical HSCT with posttransplant cyclophosphamide represents a significant advancement in alternative donor stem cell transplantation.
• The safety profile and comparable efficacy to matched HSCT broaden treatment options for patients lacking a matched donor.
• Further clinical questions regarding this platform are being addressed to optimize its application.