title: Advances in haploidentical stem cell transplantation for hematologic malignancies.
abstract: One of the most important advances in allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the use of alternative donors and cell sources, such as haploidentical transplants (haplo-HSCT) from family donors. Several approaches have been developed to overcome the challenging bidirectional alloreactivity. We discuss these approaches, including ex vivo T-cell-depleted grafts with megadose of CD34(+) cells, not requiring immunosuppression after allogeneic transplantation for graft-versus-host disease (GVHD) prophylaxis, and other strategies using unmanipulated T-cell-replete grafts with intensive immunosuppression or post-transplantation cyclophosphamide to minimize the GVHD. We also address the role of other strategies developed in the context of the haplo-HSCT platforms, such as ex vivo selective depletion of alloreactive donor T-cell subpopulations, infusion of antigen-specific T-cells against several pathogens, and infusion of regulatory T-cells, among other experimental approaches. Finally, some considerations about the selection of the most suitable donor, when more than one family member is available, are also addressed.
authors.affiliation: a Hematology Department , University Hospital La Fe and Department of Medicine, University of Valencia , Valencia , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Montoro
authors.affiliation: a Hematology Department , University Hospital La Fe and Department of Medicine, University of Valencia , Valencia , Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.affiliation: a Hematology Department , University Hospital La Fe and Department of Medicine, University of Valencia , Valencia , Spain.
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.affiliation: a Hematology Department , University Hospital La Fe and Department of Medicine, University of Valencia , Valencia , Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
mesh_terms: D064591:Allografts / Q000276:immunology; D017326:Clinical Trials, Phase III as Topic; D003520:Cyclophosphamide / Q000627:therapeutic use; D046148:Donor Selection / Q000379:methods; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens / Q000032:analysis / Q000276:immunology; D019337:Hematologic Neoplasms / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008212:Lymphocyte Depletion / Q000379:methods*; D054340:Receptors, KIR / Q000032:analysis / Q000276:immunology; D050378:T-Lymphocytes, Regulatory / Q000637:transplantation; D000075442:Transplantation, Haploidentical / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D054340:Receptors, KIR; D003520:Cyclophosphamide
keywords: Allogeneic stem cell transplantation; haploidentical SCT; hematologic malignancies