The rationale behind grafting haploidentical hematopoietic stem cells

Area of Science:

• Immunology
• Hematology
• Transplantation Science

Background:

• Hematopoietic cell transplantation (HCT) offers curative potential for hematologic disorders.
• Major histocompatibility complex (MHC) barriers limit donor availability.
• Early haploidentical HCT attempts faced challenges like graft rejection and immune deficiency.

Purpose of the Study:

• To review the evolution of haploidentical HCT strategies.
• To highlight advancements enabling HCT across MHC barriers.
• To discuss the impact of these advancements on global patient access.

Main Methods:

• Review of historical and current haploidentical HCT techniques.
• Focus on T-cell depletion strategies (broad vs. selective, ex-vivo vs. in-vivo).
• Inclusion of post-transplant cyclophosphamide as an in-vivo method.

Main Results:

• Selective T-cell depletion significantly improved HCT outcomes compared to broad depletion.
• In-vivo approaches, like post-transplant cyclophosphamide, offer facile and portable solutions.
• Technological advances have made HCT more accessible worldwide.

Conclusions:

• Modern haploidentical HCT approaches overcome MHC barriers, expanding donor pools.
• Selective T-cell depletion and in-vivo strategies have revolutionized HCT accessibility.
• These advancements enable more patients globally to access life-saving HCT procedures.