Immune reconstitution after haematopoietic stem cell transplantation: obstacles and anticipated progress.
Improvement of immune reconstitution after haematopoietic stem cell transplantation (HSCT) is a key issue determining the clinical outcome of this widely used therapeutic approach. To this end, new strategies have been prompted by recent discoveries in immunology. In the setting of human leukocyte antigen (HLA) geno(pheno)identical HSCT, better prevention and treatment of acute and chronic graft-versus-host disease (GvHD) could significantly attenuate the thymic epithelium damage responsible for delayed and incomplete T-cell reconstitution. In a haploidentical setting, methods that would significantly accelerate neothymopoiesis in the months following injection of highly purified CD34+ cells are warranted. If these objectives could be achieved, the haploidentical procedure would become more readily available to patients affected by acquired or inherited disorders of the haematopoietic system.
Cavazzana-Calvo
Marina
M
Assistance Publique Hôpitaux de Paris (AP-HP), Department of Biotherapy, Hôpital Necker Enfants-Malades, Paris, France. m.cavazzana@nck.aphp.fr
André-Schmutz
Isabelle
I
Dal Cortivo
Liliane
L
Neven
Bénédicte
B
Hacein-Bey-Abina
Salima
S
Fischer
Alain
A
D019264:Adoptive Transfer; D018952:Antigens, CD34 / Q000276:immunology; D006086:Graft vs Host Disease / Q000276:immunology* / Q000517:prevention & control / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D013601:T-Lymphocytes / Q000166:cytology / Q000276:immunology* / Q000637:transplantation; D013950:Thymus Gland / Q000166:cytology / Q000276:immunology; D014181:Transplantation Immunology
D018952:Antigens, CD34