The resurgence of haploidentical stem cell transplantation (HaploSCT) over the last decade is one of the most important advances in the field of hematopoietic stem cell transplantation (HSCT). The modified platforms of T cell depletion either ex vivo (CD34 + cell selection, “megadoses” of purified CD34 + cells, or selective depletion of T cells) or newer platforms of in vivo depletion of T cells, with either post-transplantation high-dose cyclophosphamide or intensified immune suppression, have contributed to better outcomes, with survival similar to that in HLA-matched donor transplantation. Further efforts are underway to control viral reactivation using modified T cells, improve immunologic reconstitution, and decrease the relapse rate post-transplantation using donor-derived cellular therapy products, such as genetically modified donor lymphocytes and natural killer cells. Improvements in treatment-related mortality have allowed the extension of haploidentical donor transplants to patients with hemoglobinopathies, such as thalassemia and sickle cell disease, and the possible development of platforms for immunotherapy in solid tumors. Moreover, combining HSCT from a related donor with solid organ transplantation could allow early tapering of immunosuppression in recipients of solid organ transplants and hopefully prevent organ rejection in this setting. This symposium summarizes some of the most important recent advances in HaploSCT and provides a glimpse in the future of fast growing field.
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Financial disclosure: D.C.R. has received research and travel support from Kiadis Pharma. S.O.C. has served as an advisory board member for Spectrum Pharmaceuticals, received research support from Miltenyi Biotec, and has equity/leadership in CytoSen Therapeutics. Y.R. serves as a consultant for and shareholder of Cell Source Ltd., which supported part of this work. S.S. is a cofounder of a company that is planning multicenter clinical trials of tolerance induction to combined kidney and hematopoietic cell transplants. D.A.L. has equity/leadership in CytoSen Therapeutics and equity in Courier Therapeutics.
© 2018 The American Society for Blood and Marrow Transplantation
- Cellular therapy
- Haploidentical transplantation
- Immunologic reconstitution
- Post-transplantation cyclophosphamide
- T cell depletion