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Haploidentical Transplantation: Challenges and Solutions

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Contemporary Bone Marrow Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

In the last few years, haploidentical family donor (HFD) has emerged as a front-runner for alternate donor hematopoietic cell transplantation (HCT) in hematological malignancies. The primary reason for this has been the emergence of posttransplantation cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis, which by dint of both, its ease of application and impressive outcomes, has made HFD-HCT feasible across the globe. Studies have confirmed the equivalence of HFD as compared to matched related and unrelated donor HCT in acute leukemia as well lymphomas, with low incidence of both acute and chronic GVHD. However, the risk of relapse has remained unchanged across the donor sources depending on the nature of the underlying malignancy. The different approaches to HFD-HCT have yielded similar overall survival with increase or decrease in relapse and non-relapse mortality balancing each other out, depending on the conditioning, graft manipulation, and GVHD prophylaxis. Adoptive immunotherapy following haploidentical HCT is an exciting and expanding area in HCT, with the emergence of several approaches involving natural killer cells. The application of HFD-HCT in hemoglobinopathies and other nonmalignant diseases, on the other hand, remains challenging. A better understanding of the dynamics of immune subsets in the graft among the antigen-presenting milieu in the host might enable successful tolerance induction in nonmalignant diseases, and even a dissection of a graft-versus-host and a graft-versus-leukemia effect with better precision.

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Chakrabarti, S., Jaiswal, S.R. (2021). Haploidentical Transplantation: Challenges and Solutions. In: Chandy, M., Radhakrishnan, V.S., Sukumaran, R.K. (eds) Contemporary Bone Marrow Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-030-36358-1_19

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