The haploidentical option for high-risk haematological malignancies.
Much progress has been made in the clinical, biological and technical aspects of the T-cell-depleted full-haplotype mismatched transplants for acute leukaemia. Our experience demonstrates that infusing a megadose of extensively T-cell-depleted haematopoietic peripheral blood stem cells after an immuno-myeloablative conditioning regimen in acute leukaemia patients ensures sustained engraftment with minimal GvHD without the need of any post-transplant immunosuppressive treatment. Since our first successful pilot study, our efforts have concentrated on developing new conditioning regimens, optimising the graft processing and improving the post-transplant immunological recovery. The results we have so far achieved in more than 200 high-risk acute leukaemia patients show that haploidentical transplantation is now a clinical reality. Because virtually all patients have a mismatched family member, who is immediately available, mismatched transplantation should be offered as a viable option to high-risk acute leukaemia patients who do not have, or cannot find, a matched donor.
Aversa
Franco
F
Department of Hematology, University of Perugia, Italy. aversa@unipg.it
Reisner
Yair
Y
Martelli
Massimo F
MF
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D016896:Treatment Outcome