Haploidentical stem cell transplantation (SCT) has opened up new possibilities in the treatment of severe hematologic disease. The use of allogeneic stem cell donors who are only matched for half of their HLA antigens (haploidentical donors) with the recipient, increases the regularly available donor pool for allogeneic hematopoietic SCT. The Second European Workshop on haploidentical SCT was organized in Perugia, Italy, by two of the major pioneers of the field, Massimo F Martelli (University of Perugia, Perugia, Italy) and Yair Reisner (Weizmann Institute, Rehovot, Israel). What follows is an overview of some issues that were discussed during that meeting.
Thirty percent of acute leukemia patients who need an allogeneic SCT can count on an HLA-matched family donor and another 30% on a matched unrelated donor (MUD). Until recently 40% had no donor at all and would have welcomed a fully HLA haplotype-mismatched family donor. The haploidentical hematopoietic stem cell (HSC) graft has to be depleted of T cells, because otherwise the risk of severe graft-versus-host disease (GVHD) is over 80%. On the other hand extensive T cell depletion can be associated with more than 50% graft failure. To overcome this problem, adequate conditioning regimens had to be developed and studies in animal models demonstrated that a large stem cell dose (’megadose’) had to be delivered. What follows is an overview of some of the large clinical series presented during the meeting.
This is a preview of subscription content, access via your institution