Haploidentical stem cell transplantation (SCT) strategies.
| Strategy . | Center . | Results . | Reference . |
|---|---|---|---|
| * Reduced-intensity conditioning in a minority of patients. | |||
| Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; BMT, bone marrow transplantation; DFCI, Dana-Farber Cancer Institute; DFS, disease-free survival; DLI, donor lymphocyte infusion; GVHD, graft-versus-host disease; MGH, Massachusetts General Hospital; NIMA, non-inherited maternal antigens; PBSCT, peripheral blood stem cell transplantation; TCD, T-cell depletion | |||
| MYELOABLATIVE | |||
| T-cell replete BMT | Royal Marsden | Hyperacute GVHD; frequent rejection | 1 |
| Pharmacologic GVHD Prophylaxis | Seattle | ↑ GVHD with ↑ HLA disparity | 2 |
| Partial ex vivo TCD, Post-BMT Pharmacoprophylaxis | U. South Carolina | Good GVHD Protection DFS in ~ 20% | 4 |
| “Mega-dose” TCD PBSCT | Perugia | Minimal GVHD Favorable survival in remission AML/ALL | 5,11 |
| Canada (multi-center) | Delayed immune reconstitution with high rates of relapse, infectious deaths | 12 | |
| Emory | 13 | ||
| Ex vivo T-cell anergization | Children’s/DFCI | Minimal GVHD | 6 |
| Donor selection according to fetomaternal chimerism* | Japan (multiple centers) | ↓ GVHD with donor/recipient mismatched for NIMA | 23–26 |
| NON-MYELOABLATIVE | |||
| Ex vivo/in vivo TCD, delayed DLI | MGH | “split level” mixed chimerism, conversion of T-cell chimerism after DLI | 7,8 |
| Post-BMT high-dose cyclophosphamide | Johns Hopkins | Full donor chimerism in most, GVHD in ~ 50% | 17 |
| Ex vivo/in vivo TCD with Campath | Duke | Low incidence of acute GVHD, high incidence of GVHD after DLI | Personal communication N. Chao |
| Strategy . | Center . | Results . | Reference . |
|---|---|---|---|
| * Reduced-intensity conditioning in a minority of patients. | |||
| Abbreviations: ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; BMT, bone marrow transplantation; DFCI, Dana-Farber Cancer Institute; DFS, disease-free survival; DLI, donor lymphocyte infusion; GVHD, graft-versus-host disease; MGH, Massachusetts General Hospital; NIMA, non-inherited maternal antigens; PBSCT, peripheral blood stem cell transplantation; TCD, T-cell depletion | |||
| MYELOABLATIVE | |||
| T-cell replete BMT | Royal Marsden | Hyperacute GVHD; frequent rejection | 1 |
| Pharmacologic GVHD Prophylaxis | Seattle | ↑ GVHD with ↑ HLA disparity | 2 |
| Partial ex vivo TCD, Post-BMT Pharmacoprophylaxis | U. South Carolina | Good GVHD Protection DFS in ~ 20% | 4 |
| “Mega-dose” TCD PBSCT | Perugia | Minimal GVHD Favorable survival in remission AML/ALL | 5,11 |
| Canada (multi-center) | Delayed immune reconstitution with high rates of relapse, infectious deaths | 12 | |
| Emory | 13 | ||
| Ex vivo T-cell anergization | Children’s/DFCI | Minimal GVHD | 6 |
| Donor selection according to fetomaternal chimerism* | Japan (multiple centers) | ↓ GVHD with donor/recipient mismatched for NIMA | 23–26 |
| NON-MYELOABLATIVE | |||
| Ex vivo/in vivo TCD, delayed DLI | MGH | “split level” mixed chimerism, conversion of T-cell chimerism after DLI | 7,8 |
| Post-BMT high-dose cyclophosphamide | Johns Hopkins | Full donor chimerism in most, GVHD in ~ 50% | 17 |
| Ex vivo/in vivo TCD with Campath | Duke | Low incidence of acute GVHD, high incidence of GVHD after DLI | Personal communication N. Chao |