Haploidentical Hematopoietic Stem Cell Transplantation With a Megadose T-Cell-Depleted Graft: Harnessing Natural and Adaptive Immunity

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• 作者：Franco Aversa^a ; ^{franco.aversa@unipr.it} ; Massimo F. Martelli^b ; Andrea Velardi^c
• 刊名：Seminars in Oncology
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：39
• 期：6
• 页码：643-652
• 全文大小：295 K

文摘

For patients with high-risk acute leukemia who do not have a matched donor or who urgently need a transplant, transplantation from a full human leukocyte antigen (HLA) haplotype mismatched family donor should be considered a viable option. Clinical trials have shown that a strategy for haploidentical transplantation based on the infusion of high numbers of T-cell-depleted hematopoietic progenitor cells and no post-transplant immunosuppression controls bi-directional T-cell alloreactivity, ie, graft rejection and graft-versus-host disease (GvHD) in patients with leukemia. Overall, event-free survival compares favorably with reports of transplants using sources of stem cells other than the matched sibling. This transplant modality has highlighted the crucial role of donor-versus-recipient natural killer cell (NK) alloreactivity in the control of leukemia relapse. Current studies are focusing on rebuilding post-transplant immunity to improve clinical outcomes.