Allogeneic transplantation across major HLA barriers

Best Practice & Research. Clinical Haematology
P J Henslee-Downey

Abstract

Only one-fourth of patients with fatal haematological disorders and malignancies will have an HLA-matched sibling donor to create access to potentially curative allogeneic stem cell transplantation. Advances in medical management, preparation of the graft and prevention of transplant-related complications, particularly rejection and GVHD, now make it possible to use alternative donors who are not genetically HLA-histocompatible with the patient. Some patients identify unrelated donor options using adult volunteers or cord blood units. All patients have immediate access to one or more genetically half-matched (haplo-identical), HLA partially-mismatched related donors. Using safer non-cytotoxic therapies to ablate the patient's immune system, graft preparation to decrease T-lymphocyte and/or increase CD 34+ cell doses, and post-transplant GVHD and infection prophylaxis, rates >95% for engraftment and <25% for grade II-IV GVHD can be achieved. Thus, disease-free survival rates are comparable to other alternative donors with all outcomes adversely influenced by advanced disease status, poor medical performance and older age.

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Citations

Nov 13, 2008·Cytotechnology·Andrew D ClarkTessa L Holyoake
Sep 25, 2008·Bone Marrow Transplantation·L-P Koh, N Chao
May 23, 2012·Expert Review of Clinical Immunology·Ekapun Karoopongse, H Joachim Deeg
Sep 22, 2007·Blood Cells, Molecules & Diseases·Liang-Piu Koh, Nelson J Chao
Apr 20, 2007·Annals of the New York Academy of Sciences·Rupert HandgretingerPeter Lang
May 16, 2012·Pediatric Transplantation·Justus LieberJörg Fuchs
Sep 26, 2006·Best Practice & Research. Clinical Haematology·Jakob R PasswegAndré Tichelli
Oct 24, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Liang-Piu KohNelson J Chao
Jan 1, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Mitchell S CairoJohn Wagner
Jan 18, 2005·Bone Marrow Transplantation·J R PasswegA Tichelli

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