Evolution of the role of haploidentical stem cell transplantation: past, present, and future

Expert Rev Hematol. 2020 Aug;13(8):835-850. doi: 10.1080/17474086.2020.1796621. Epub 2020 Aug 4.

Abstract

Introduction: The accessibility to haplo-donors has led to an increase in the number of haplo-HSCT worldwide. A systematic search of the PubMed database between 2000 to present was performed.

Areas covered: In this review, the authors discussed the most used approaches to perform haplo-HSCT and its results: T-cell depletion (TCD, including Perugia platform and its modifications) and T-cell repleted haplo (TCR, including the high-dose post-transplant cyclophosphamide strategy (Baltimore protocol) and the Beijing protocol). The improvements and modifications made to the different strategies have increased the indications of haplo-HSCT, including both malignant and nonmalignant disorders. Focusing on the Baltimore protocol, the authors review the results of the retrospective studies that have compared it to other donor transplants. The limitations of this strategy in terms of toxicity, graft complications, and GVHD are also discussed in detail. Finally, possible approaches to improve the outcomes of TCR haplo-HSCT are presented.

Expert opinion: The recent advances in the field of haplo-HSCT have allowed a large number of patients with incurable diseases to benefit from this procedure despite not having a matched donor. With all available strategies, virtually no patient who needs an allogeneic transplant should be excluded by the absence of a donor.

Keywords: Haploidentical stem cell transplantation; T-cell depleted; T-cell repleted.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Disease Management
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / etiology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cell Transplantation* / methods
  • Hematopoietic Stem Cell Transplantation* / trends
  • Histocompatibility Testing
  • Humans
  • Immune Reconstitution
  • Lymphocyte Depletion / adverse effects
  • Lymphocyte Depletion / methods
  • Patient Outcome Assessment
  • Postoperative Complications
  • Tissue Donors
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods
  • Transplantation, Haploidentical* / adverse effects
  • Transplantation, Haploidentical* / methods
  • Transplantation, Haploidentical* / trends