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Haploidentical Hematopoietic Cell Transplantation in Lymphomas

  • Guru Subramanian Guru Murthy
  • Mehdi Hamadani
  • Parameswaran N. Hari
Chapter
Part of the Advances and Controversies in Hematopoietic Transplantation and Cell Therapy book series (ACHTCT)

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative salvage treatment for patients with lymphoproliferative disorders (LPDs). In the United States, it is estimated that about 19,790 patients with non-Hodgkin lymphoma (NHL) and 1150 patients with Hodgkin lymphoma died in the calendar year of 2015. Progressive disease is a leading cause of mortality in patients with lymphomas. Although allo-HCT appears to be an attractive treatment option for patients with advanced lymphomas, its widespread application is often limited by factors such as HLA-matched donor availability and the risk of post-transplant morbidity. Haploidentical HCT (haplo-HCT) expands the allo-HCT strategy to patients without an available fully HLA-matched adult donor, while novel haplo-HCT techniques have improved the safety of this approach. Historically, in the haploidentical setting, severe graft-versus-host disease (GvHD), higher risk of non-relapse mortality (NRM), disease relapse, and delayed immune reconstitution were challenges despite extensive in vivo or ex vivo T-cell depletion aimed at reduced graft rejection and GvHD risk. More recently, several Asian centers have reported favorable outcomes of haplo-HCT utilizing T-cell replete grafts with intensive immunosuppression using antithymocyte globulin (ATG). A different strategy of T-cell replete haplo-HCT being increasingly used involves the administration of high-dose post-transplantation cyclophosphamide (PTCy), which mitigates the risk of GvHD by targeting alloreactive T-cells rapidly proliferating early after HLA-mismatched transplant while sparing regulatory T-cells and hematopoietic progenitor cells. The near universal and ease of haploidentical donor availability have led to a rapid adoption of this strategy in patients with LPDs.

Keywords

Haploidentical transplants Post-transplant cyclophosphamide NMA Myeloablative Relapse GvHD Lymphoma HL NHL Conditioning 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Guru Subramanian Guru Murthy
    • 1
  • Mehdi Hamadani
    • 1
    • 2
  • Parameswaran N. Hari
    • 1
    • 2
  1. 1.Division of Hematology and OncologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Center for International Blood and Marrow Transplant ResearchMilwaukeeUSA

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