title: Experts' considerations on HLA-haploidentical stem cell transplantation.
abstract: Recently, novel strategies to control graft-versus-host disease and facilitate engraftment have allowed an increasing number of human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (haploHSCT) to be performed. A meeting was convened to review the biological rationale and the clinical results of various T-cell-depleted (TCD) and T-cell-replete (TCR) HLA-haploidentical 'transplant platforms'. The objective of the meeting was to promote discussion and consent among leading researchers in the field on three main crucial issues for haploHSCT: (i) eligibility criteria, (ii) choice of the most suitable donor, and (iii) choice of the most appropriate transplant platform. The experts in attendance agreed that a patient who is eligible for an allogeneic transplant and lacks an HLA-identical sibling or an HLA-matched unrelated donor should be considered for an alternative donor transplant. Together with the experience of the individual center, the most important decision criteria in choosing an alternative donor source should be the rapidity of transplantation so as to avoid disease relapse/progression. The choice of the mismatched donor should be driven by younger age, ABO blood group compatibility, and Cytomegalovirus status. If a TCD transplant is planned, NK-alloreactive donors and/or the mother should be preferred. Prospective comparative studies are needed to establish the relative efficacy of different transplant platforms. However, expertise in stem cell manipulation and in adoptive immunotherapy is essential if a TCD transplant platform is chosen.
authors.affiliation: Department of Hematology, Stem Cell Transplant Unit, DISM, University Hospital, Udine, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.forename: Marta
authors.initials: M
authors.lastname: Medeot
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolomeo
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.forename: Luca
authors.initials: L
authors.lastname: Vago
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Kanakry
authors.forename: Katharina
authors.initials: K
authors.lastname: Fleischhauer
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Martelli
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D003226:Congresses as Topic; D003586:Cytomegalovirus Infections / Q000175:diagnosis; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016219:Immunotherapy, Adoptive; D008212:Lymphocyte Depletion; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D018579:Patient Selection; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists
keywords: HLA-haploidentical donors; T-cell depletion; allogeneic stem cell transplantation; post-transplantation cyclophosphamide