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Post-transplant Cyclophosphamide in Haploidentical Transplantation

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

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.

Keywords

Haploidentical transplantation Post-transplant cyclophosphamide Lymphoma Graft-versus-host disease Immune reconstitution Graft failure 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Hematologic MalignanciesSidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimoreUSA

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