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Unique Complications and Limitations of Haploidentical Hematopoietic Cell Transplant

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Haploidentical Transplantation

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Abstract

Outcomes of haploidentical hematopoietic cell transplantation (haplo-HCT) have recently improved. In the past, limitations in expanding this form of transplant were related to profound in vivo and ex vivo T-cell depletion to avoid both primary graft rejection (PGF) and lethal graft-versus-host disease (GvHD). Consequently, T-lymphocyte reconstitution was markedly hindered leading to significant rates of lethal infections associated with high rates of non-relapse mortality (NRM) and relapse of the malignant disease, limiting this strategy only to patients with no suitable donor in place. Recent developments during the last 5 years have changed this scenario dramatically. Novel strategies allowing the add-back of manipulated and selected depletion of T-lymphocytes and post-transplant alloreactive T-cell depletion (TCD) by high-dose cyclophosphamide after unmanipulated bone marrow (BM) or peripheral blood (PB) hematopoietic cell transplantation reach out to almost similar outcomes known from transplants from HLA-matched related and HLA-matched unrelated donors.

Here, we summarize the unique complications of haplo-HCT related to the immunological consequences of crossing the major histocompatibility barrier and potent immunosuppression required during the process of transplantation, such as PGF, genomic loss of HLA-mismatched human leukocyte antigen and viral reactivation, and a consequence of delayed or incomplete immune reconstitution.

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Authors and Affiliations

  1. Department of Internal Medicine II, University of Wuerzburg, Wuerzburg, Germany

    Hermann Einsele, Stephan Mielke & Matthias Hermann

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  1. Hermann Einsele
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  2. Stephan Mielke
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  3. Matthias Hermann
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Correspondence to Hermann Einsele .

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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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Einsele, H., Mielke, S., Hermann, M. (2018). Unique Complications and Limitations of Haploidentical Hematopoietic Cell Transplant. 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_20

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  • DOI: https://doi.org/10.1007/978-3-319-54310-9_20

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