Future directions in haploidentical hematopoietic stem cell transplantation
1
Issued Date
2024-01-01
Resource Type
ISSN
10245332
eISSN
16078454
Scopus ID
2-s2.0-85196320666
Journal Title
Hematology (United Kingdom)
Volume
29
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hematology (United Kingdom) Vol.29 No.1 (2024)
Suggested Citation
Vittayawacharin P., Kongtim P., Ciurea S.O. Future directions in haploidentical hematopoietic stem cell transplantation. Hematology (United Kingdom) Vol.29 No.1 (2024). doi:10.1080/16078454.2024.2366718 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/99003
Title
Future directions in haploidentical hematopoietic stem cell transplantation
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Abstract
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.