title: "Designed" grafts for HLA-haploidentical stem cell transplantation.
abstract: Today human leukocyte antigen-haploidentical transplantation is a feasible option for patients with high-risk acute leukemia who do not have matched donors. Whether it is T-cell replete or T-cell depleted, it is still, however, associated with issues of transplant-related mortality and posttransplant leukemia relapse. After reports that adoptive immunotherapy with T-regulatory cells controls the alloreactivity of conventional T lymphocytes in animal models, tomorrow's world of haploidentical transplantation will focus on new "designed" grafts. They will contain an appropriate ratio of conventional T lymphocytes and T-regulatory cells, natural killer cells, γ δ T cells, and other accessory cells. Preliminary results of ongoing clinical trials show the approach is feasible. It is associated with better immune reconstitution and a quite powerful graft-versus-leukemia effect with a low incidence of graft-versus-host disease and no need for posttransplant pharmacological prophylaxis. Future strategies will focus on enhancing the clinical benefit of T-regulatory cells by increasing their number and strengthening their function.
authors.affiliation: Hematology and Clinical Immunology Section, Department of Clinical and Experimental Medicine, University of Perugia, Italy;
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Martelli
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Ianni
authors.forename: Loredana
authors.initials: L
authors.lastname: Ruggeri
authors.forename: Antonio
authors.initials: A
authors.lastname: Pierini
authors.forename: Franca
authors.initials: F
authors.lastname: Falzetti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carotti
authors.forename: Adelmo
authors.initials: A
authors.lastname: Terenzi
authors.forename: Yair
authors.initials: Y
authors.lastname: Reisner
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.forename: Brunangelo
authors.initials: B
authors.lastname: Falini
authors.forename: Andrea
authors.initials: A
authors.lastname: Velardi
mesh_terms: D000818:Animals; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000639:trends; D006648:Histocompatibility / Q000502:physiology*; D006801:Humans; D008212:Lymphocyte Depletion / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods / Q000639:trends; D014181:Transplantation Immunology / Q000502:physiology; D019737:Transplants / Q000276:immunology
chemical_list: D006680:HLA Antigens