Future directions in haploidentical hematopoietic stem cell transplantation
Outcomes of haploidentical hematopoietic stem cell transplantation (haplo-SCT) have improved over time. Graft failure and graft-versus-host disease (GVHD), which were important complications in major human leukocyte antigen (HLA)-disparity stem cell transplantation, have significantly decreased. The...
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Taylor & Francis Group
2024-12-01
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| Series: | Hematology |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/16078454.2024.2366718 |
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| author | Pongthep Vittayawacharin Piyanuch Kongtim Stefan O. Ciurea |
| author_facet | Pongthep Vittayawacharin Piyanuch Kongtim Stefan O. Ciurea |
| author_sort | Pongthep Vittayawacharin |
| collection | DOAJ |
| description | Outcomes of haploidentical hematopoietic stem cell transplantation (haplo-SCT) have improved over time. Graft failure and graft-versus-host disease (GVHD), which were important complications in major human leukocyte antigen (HLA)-disparity stem cell transplantation, have significantly decreased. These improvements have led to an exponential increase in the use of haploidentical donors for transplantation, as well as in the number of publications evaluating haplo-SCT outcomes. Many studies focused on factors important in donor selection, novel conditioning regimens or GVHD prophylaxis, the impact of donor-specific anti-HLA antibodies (DSA), as well as strategies to prevent disease relapse post-transplant. DSA represents an important limitation and multimodality desensitization protocols, including plasma exchange, rituximab, intravenous immunoglobulin and donor buffy coat infusion, can contribute to the successful engraftment in patients with high DSA levels and is currently the standard therapy for highly allosensitized individuals. With regards to donor selection, younger donors are preferred due to lower risk of complications and better transplant outcomes. Moreover, recent studies also showed that younger haploidentical donors may be a better choice than older-matched unrelated donors. Improvement of disease relapse remains a top priority, and several studies have demonstrated that higher natural killer (NK) cell numbers early post-transplant are associated with improved outcomes. Prospective studies have started to assess the role of NK cell administration in decreasing post-transplant relapse. These studies suggest that the incorporation of other cell products post-transplant, including the administration of chimeric antigen receptor T-cells, should be explored in the future. |
| format | Article |
| id | doaj-art-bd8518eacbb34ab190fea7107096a383 |
| institution | DOAJ |
| issn | 1607-8454 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
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| series | Hematology |
| spelling | doaj-art-bd8518eacbb34ab190fea7107096a3832025-08-20T02:50:19ZengTaylor & Francis GroupHematology1607-84542024-12-0129110.1080/16078454.2024.2366718Future directions in haploidentical hematopoietic stem cell transplantationPongthep Vittayawacharin0Piyanuch Kongtim1Stefan O. Ciurea2Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USAHematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USAHematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USAOutcomes of haploidentical hematopoietic stem cell transplantation (haplo-SCT) have improved over time. Graft failure and graft-versus-host disease (GVHD), which were important complications in major human leukocyte antigen (HLA)-disparity stem cell transplantation, have significantly decreased. These improvements have led to an exponential increase in the use of haploidentical donors for transplantation, as well as in the number of publications evaluating haplo-SCT outcomes. Many studies focused on factors important in donor selection, novel conditioning regimens or GVHD prophylaxis, the impact of donor-specific anti-HLA antibodies (DSA), as well as strategies to prevent disease relapse post-transplant. DSA represents an important limitation and multimodality desensitization protocols, including plasma exchange, rituximab, intravenous immunoglobulin and donor buffy coat infusion, can contribute to the successful engraftment in patients with high DSA levels and is currently the standard therapy for highly allosensitized individuals. With regards to donor selection, younger donors are preferred due to lower risk of complications and better transplant outcomes. Moreover, recent studies also showed that younger haploidentical donors may be a better choice than older-matched unrelated donors. Improvement of disease relapse remains a top priority, and several studies have demonstrated that higher natural killer (NK) cell numbers early post-transplant are associated with improved outcomes. Prospective studies have started to assess the role of NK cell administration in decreasing post-transplant relapse. These studies suggest that the incorporation of other cell products post-transplant, including the administration of chimeric antigen receptor T-cells, should be explored in the future.https://www.tandfonline.com/doi/10.1080/16078454.2024.2366718Haploidentical hematopoietic stem cell transplantationyounger haploidentical donorNK cell alloreactivityKIRbuffy coatdonor-specific anti-HLA antibodies |
| spellingShingle | Pongthep Vittayawacharin Piyanuch Kongtim Stefan O. Ciurea Future directions in haploidentical hematopoietic stem cell transplantation Hematology Haploidentical hematopoietic stem cell transplantation younger haploidentical donor NK cell alloreactivity KIR buffy coat donor-specific anti-HLA antibodies |
| title | Future directions in haploidentical hematopoietic stem cell transplantation |
| title_full | Future directions in haploidentical hematopoietic stem cell transplantation |
| title_fullStr | Future directions in haploidentical hematopoietic stem cell transplantation |
| title_full_unstemmed | Future directions in haploidentical hematopoietic stem cell transplantation |
| title_short | Future directions in haploidentical hematopoietic stem cell transplantation |
| title_sort | future directions in haploidentical hematopoietic stem cell transplantation |
| topic | Haploidentical hematopoietic stem cell transplantation younger haploidentical donor NK cell alloreactivity KIR buffy coat donor-specific anti-HLA antibodies |
| url | https://www.tandfonline.com/doi/10.1080/16078454.2024.2366718 |
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