Transplant Outcomes in Acute Leukemia (II)
Section snippets
HFD HSCT for Acute Leukemia
Early experiences attempting HFD HSCT were frustrated by poor engraftment and a prohibitive incidence of graft-versus-host disease (GVHD),4, 5, 6 consequent on the difficulties of crossing major histocompatibility barriers. However, considerable progress has been made over the last two decades; vigorous T-cell depletion, using automated technology, has reduced the incidence of GVHD to a level comparable with URD HSCT7, 8, 9, 10 and high primary engraftment rates can now be achieved by the
Comparison of HFD HSCT With Other Stem Cell Sources
Table 2 summarizes studies that have compared the outcomes of HFD HSCT with other stem cell sources for acute leukemia.
The Eurocord group, in collaboration with the Acute Leukemia Working Party and the Pediatric Diseases Working Party of the EBMT, have retrospectively compared the outcome of both children and adults given either a single-unit UCB transplant (UCBT) or HFD HSCT35, 36 (Table 2). Children (16 years or younger) had received either HFD HSCT (n = 118) or UCBT (n = 341) in
Donor Selection Hierarchy for Patients With Acute Leukemia
This review and the preceding article have summarized the current status of URD and alternative donor transplantation for children and adults with acute leukemia and have demonstrated that, in the absence of an HLA-matched sibling donor, unrelated donor BMT (UBMT), UCBT, and HFD HSCT offer acceptable alternative stem cell sources for allogeneic transplantation (Table 3).
In children, matched (antigen level at HLA-A and -B, allelic level at HLA-DRB1) UCBT is at least equivalent and possibly
Conclusion
Allogeneic HSCT is the only curative therapy currently available for patients with selected high-risk acute leukemia. It is now possible to find a suitable donor for almost all patients. We have outlined donor selection algorithms based on current best evidence. Such strategies will undoubtedly evolve over time as further technological advances are made in the specific approaches described.
References (46)
- et al.
Paucity of HLA-identical unrelated donors for African-Americans with hematologic malignancies: the need for new donor options
Biol Blood Marrow Transplant
(2008) - et al.
Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow
Biol Blood Marrow Transplant
(2002) - et al.
Mismatched family donors for bone-marrow transplantation as treatment for acute leukaemia
Lancet
(1983) - et al.
Effect of HLA incompatibility in marrow transplantation from unrelated and HLA-mismatched related donors
Transfus Sci
(1994) - et al.
Tolerance induction by āmegadoseā transplants of CD34+ stem cells: a new option for leukemia patients without an HLA-matched donor
Curr Opin Immunol
(2000) - et al.
Use of partially mismatched related donors extends access to allogeneic marrow transplant
Blood
(1997) - et al.
A survey of fully haploidentical hematopoietic stem cell transplantation in adults with high-risk acute leukemia: a risk factor analysis of outcomes for patients in remission at transplantation
Blood
(2008) - et al.
Experiences with haploidentical stem cell transplantation in children with acute lymphoblastic leukemia
Pathol Biol (Paris)
(2005) - et al.
Donor natural killer cell allorecognition of missing self in haploidentical hematopoietic transplantation for acute myeloid leukemia: challenging its predictive value
Blood
(2007) - et al.
Long-term outcome after haploidentical stem cell transplantation in children
Blood Cells Mol Dis
(2004)
Survival after T cell-depleted haploidentical stem cell transplantation is improved using the mother as donor
Blood
Haploidentical stem cell transplantation following a reduced-intensity conditioning regimen for the treatment of advanced hematologic malignancies: post-transplant CD8-depleted donor lymphocyte infusions contribute to improve T-cell recovery
Blood
Transferring functional immune responses to pathogens after haploidentical hematopoietic transplantation
Blood
Preemptive therapy of EBV-related lymphoproliferative disease after pediatric haploidentical stem cell transplantation
Am J Transplant
Innovative approaches of adoptive immune cell therapy in paediatric recipients of haematopoietic stem cell transplantation
Best Pract Res Clin Haematol
Cotransplantation of ex vivo expanded mesenchymal stem cells accelerates lymphocyte recovery and may reduce the risk of graft failure in haploidentical hematopoietic stem-cell transplantation
Blood
Superior survival associated with transplantation of matched unrelated versus one-antigen-mismatched unrelated or highly human leukocyte antigen-disparate haploidentical family donor marrow grafts for the treatment of hematologic malignancies: establishing a treatment algorithm for recipients of alternative donor grafts
Blood
HLA-haploidentical blood and bone marrow transplantation with anti-thymocyte globulin: long-term comparison with HLA-identical sibling transplantation
Blood Cells Mol Dis
Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study
Lancet
Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen-matched unrelated donor bone marrow: results of a matched-pair analysis
Blood
Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia
Blood
Hematopoietic stem-cell transplantation
N Engl J Med
Marrow transplantation from related donors other than HLA-identical siblings
N Engl J Med
Cited by (0)
R.H. is a trustee of the UK Cord Blood Charity.