Allogeneic transplantation across the HLA barriers.
In high-risk acute leukemia patients, a 10-fold increase in the dose of extensively T-cell-depleted hematopoietic stem cells ensures sustained full-donor engraftment of one-haplotype-mismatched transplants without graft-vs.-host disease. Since our first successful pilot study, which exploited the principle of a megadose stem cell transplant, our efforts have concentrated on developing new conditioning regimens, optimizing graft processing and improving the post-transplant immunologic recovery. The results so far achieved in more than 100 high-risk acute leukemia patients show that haploidentical transplantation is now a clinical reality. Because virtually all patients in need of a hematopoietic stem cell transplant have a full-haplotype-mismatched family donor, a T-cell-depleted mismatched transplant can be offered with curative intent, thus extending allogeneic transplantation procedures to virtually all candidates.
Aversa
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Hematopoietic Stem Cell Transplant Program, Section of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy. aversa@unipg.it
Tabilio
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Velardi
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Martelli
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MF
D000208:Acute Disease; D006239:Haplotypes / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality / Q000592:standards; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000401:mortality / Q000628:therapy; D010865:Pilot Projects; D014184:Transplantation, Homologous