The use of haploidentical stem cell transplant as an alternative donor source in patients with decreased access to matched unrelated donors

Autor: Christopher Graham, Mark Litzow
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Hematology, Vol 29, Iss 1 (2024)
Druh dokumentu: article
ISSN: 16078454
1607-8454
DOI: 10.1080/16078454.2024.2338300
Popis: Introduction The likelihood of finding HLA-matched unrelated donors for rare HLA types and non-white European ancestry continues to be a challenge with less than a 70% chance of finding a full match. Mismatched transplants continue to have high rates of transplant-related mortality. With the near-universal ability to find a haploidentical donor in families, haploidentical transplants have become of more critical importance in ethnic minority groups and patients with rare HLA types.Methods Data was collected through clinical trials, review articles, and case reports published in the National Library of Medicine.Results The use of improved lymphodepleting conditioning regimens, graft versus host disease (GVHD) prophylaxis using regimens such as post-transplant cyclophosphamide, mycophenolate, and tacrolimus have improved engraftment to nearly 100 percent and reduced transplant-related mortality to less than 20 percent. Attention to donor-specific antibodies (DSAs) with interventions using bortezomib, rituximab, and plasmapheresis has decreased graft failure rates.Conclusion With improved prevention of GVHD with interventions such as post-transplant cyclophosphamide and management of DSAs, haploidentical transplants continue to improve transplant-related mortality (TRM) compared to patients who received matched-related donor transplants. While TRM continues to improve, ongoing research with haploidentical transplants will focus on improving graft and donor immunosuppression and identifying the best regimens to improve TRM without compromising relapse-free survival.
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