Partially HLA-mismatched related, or HLA-haploidentical, donor stem cell transplantation (SCT) is a feasible therapeutic option for advanced hematologic malignancies patients who lack an HLA-matched related or unrelated donor. Advances in conditioning regimens, graft manipulation, and pharmacologic prophylaxis of graft-versus-host disease (GVHD) have reduced the risk of fatal graft failure and severe GVHD, two of the most serious complications of traversing the HLA barrier. Clinical observations reveal a potential role for natural killer (NK) cell alloreactivity in reducing the risk of relapse of acute myeloid leukemia after HLA-haploidentical SCT. NK cell infusions attempt to harness the graft-versus-leukemia effect without producing GVHD. The availability of multiple potential HLA-haploidentical related donors for most patients opens the possibility of optimizing transplantation outcome through intelligent donor selection.
Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.