Haploidentical Transplants and NK Cell Alloreactivity

  • Andrea Velardi
Part of the Advances and Controversies in Hematopoietic Transplantation and Cell Therapy book series (ACHTCT)


Allogeneic hematopoietic cell transplantation is the most powerful form of immunotherapy for neoplastic hematological diseases as well as selected nonmalignant hematological disorders. Matching donor and recipient at HLA level is crucial for optimal transplant outcomes with acceptable non-relapse mortality. However, only 25% of individuals have an HLA-identical sibling who could serve as donor. Alternative hematopoietic graft sources are HLA-matched unrelated volunteers, unrelated umbilical cord blood units, and HLA haplotype-mismatched (“haploidentical”) family members which are, however, associated with up to 40% NRM due to diverse combinations of graft failure, GvHD, hepatic sinusoidal obstruction syndrome, and infections. Donor-versus-recipient NK cell alloreactivity is now established as a key therapeutic element in T-cell-depleted haploidentical hematopoietic transplantation for acute myeloid leukemia. Under T-cell-replete protocols, the benefits of NK cell alloreactivity might be expected to be antagonized/obscured as was reported in unrelated donor and cord blood transplantation. The only exception so far documented is the haploidentical hematopoietic cell transplant trial with Treg/Tcon add-backs that, however, do not use any posttransplant pharmacologic immunosuppressive GvHD prophylaxis. In this chapter we will discuss the various methods used in studies to augment NK cell alloreactivity in haploidentical transplantation.


Haploidentical transplant NK cells GvHD GvT-cell depletion HvKIR Alloreactivity 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Blood and Marrow Transplant ProgramUniversity of PerugiaPerugiaItaly

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