Hematopoietic Stem Cell Transplantation from Alternative Donors for High-Risk Acute Leukemia: The Haploidentical Option

Franco      Aversa; Antonio      Tabilio; Andrea      Velardi; Adelmo      Terenzi; Franca      Falzetti; Alessandra      Carotti; Teresa      Aloisi; Maria      Liga; Mauro      Di Ianni; Tiziana      Zei; Antonella      Santucci; Massimo      F. Martelli

Abstract

Much progress has been made in the clinical, biological and technical aspects of the T-cell-depleted full-haplotype mismatched transplants for acute leukemia. Our experience demonstrates that infusing a megadose of extensively T-cell-depleted hematopoietic peripheral blood stem cells after an immunomyeloablative conditioning regimen in acute leukemia patients ensures sustained engraftment with minimal graft-vs-host disease (GvHD) without the need of any post-transplant immunosuppressive treatment. Since our first successful pilot study, our efforts have concentrated on developing new conditioning regimens, optimizing the graft processing and improving the post-transplant immunological recovery. The results we have so far achieved in more than 200 high-risk acute leukemia patients show that haploidentical transplantation is now a clinical reality. Because virtually all patients in need of a hematopoietic stem cell transplant have a full-haplotype mismatched donor, who is immediately available, a T-cell depleted mismatched transplant should be offered, not as a last resort, but as a viable option to high risk acute leukemia patients who do not have, or cannot find, a matched donor.

Keywords: Haploidentical transplantation, high-risk acute leukemia, T-cell depletion, NK cell alloreactivity

« Previous Next »