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Post-transplant Cyclophosphamide in Haploidentical Transplantation

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Haploidentical Transplantation

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Abstract

HLA-matched sibling donors are available for only a minority of patients. Partially HLA-mismatched related (HLA-haploidentical) donors can be identified for the vast majority of patients, but transplants from these donors have historically been limited by excessive graft-versus-host disease, nonrelapse mortality, and poor overall survival. When given on days 3 and 4 after HLA-haploidentical T-cell replete blood or marrow transplantation, high-dose cyclophosphamide depletes dividing alloreactive T-cells, resulting in low rates of acute graft-versus-host disease, comparable to HLA-matched transplantation, and chronic graft-versus-host disease incidence below that seen with T-cell replete HLA-matched transplantation. Importantly, cyclophosphamide spares non-alloreactive T-cells, preserving immunity and leading to a low incidence of nonrelapse mortality after HLA-haploidentical transplantation. HLA-haploidentical transplantation utilizing post-transplant cyclophosphamide achieves comparable survival to HLA-matched transplantation and has thereby expanded the option of allogeneic transplantation to the vast majority of eligble recipients.

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Authors and Affiliations

  1. Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    Shannon R. McCurdy & Ephraim J. Fuchs

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  1. Shannon R. McCurdy
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  2. Ephraim J. Fuchs
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Correspondence to Shannon R. McCurdy .

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  1. Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas, USA

    Stefan O. Ciurea

  2. Department of General Pediatrics and Hematology/Oncology, University Children’s Hospital, Tübingen, Baden-Württemberg, Germany

    Rupert Handgretinger

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McCurdy, S.R., Fuchs, E.J. (2018). Post-transplant Cyclophosphamide in Haploidentical Transplantation. In: Ciurea, S., Handgretinger, R. (eds) Haploidentical Transplantation. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-54310-9_7

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