HLA-Haploidentical Stem Cell Transplantation for Hematologic Malignancies
Received 15 September 2009; accepted 29 October 2009. published online 04 November 2009.
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.
1Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
2Institute of Hematology, People's Hospital, Peking University, Beijing, People's Republic of China
3Division of Hematology, Oncology and Transplantation, University of Minnesota Cancer Center, Minneapolis, Minnesota
Correspondence and reprint requests: Ephraim J. Fuchs, M.D., M.B.A., Division of Hematologic Malignancies, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 488 Cancer Research Building, 1650 Orleans Street, Baltimore, MD 21231.
Financial disclosure: See Acknowledgments on page 62.
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