Hematopoietic stem cell transplantation from alternative donors for high-risk acute leukemia: the haploidentical option.
Much progress has been made in the clinical, biological and technical aspects of the T-cell-depleted full-haplotype mismatched transplants for acute leukemia. Our experience demonstrates that infusing a megadose of extensively T-cell-depleted hematopoietic peripheral blood stem cells after an immuno-myeloablative conditioning regimen in acute leukemia patients ensures sustained engraftment with minimal graft-vs-host disease (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, optimizing the graft processing and improving the post-transplant immunological recovery. The results we have so far achieved in more than 200 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 donor, who is immediately available, a T-cell depleted mismatched transplant should be offered, not as a last resort, but as a viable option to high risk acute leukemia patients who do not have, or cannot find, a matched donor.
Aversa
Franco
F
Hematopoietic Stem Cell Transplant Unit, Section of Hematology and Immunology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia 06100, Italy. aversa@unipg.it
Tabilio
Antonio
A
Velardi
Andrea
A
Terenzi
Adelmo
A
Falzetti
Franca
F
Carotti
Alessandra
A
Aloisi
Teresa
T
Liga
Maria
M
Di Ianni
Mauro
M
Zei
Tiziana
T
Santucci
Antonella
A
Martelli
Massimo F
MF
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D006086:Graft vs Host Disease; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D014019:Tissue Donors; D016896:Treatment Outcome