Volumen: 21 # Number : 1°er Cong. de Trasplante de Células Progenitoras Hematopoyéticas - 2°do Congreso del LABMT
Publication Date : Marzo Year: 2017
Is haploidentical HSCT for leukemias a valid alternative or still a second choice?
Authors: Corbacioglu S
Abstract: Pediatric acute lymphoblastic leukemia (ALL) has
cure rates of over 90% in many developed countries
and the relapse rates are continuously declining
over the last decades. Ostensibly, this development
leaves only few patients with an indication for an
allogeneic hematopoietic stem cell transplantation
(HSCT). But the increasing cure rates in children
is accompanied by an exponentially rising curve of
treatment related morbidity and mortality. In adult
ALL the development is similar, but with cure rates
roughly half those seen in children. Major advances
in hematopoietic stem cell transplantation (HSCT)
over the last decade have substantially decreased
transplant-related morbidity and mortality. A major
recent development in HSCT is the exponential use
of haploidentical HSCT (haplo-HSCT) based on
the ubiquitously availability of the post-transplant
cyclophosphamide approach for low cost. Also,
T-depleted haploidentical transplantation advanced
clearly, so that haploidentical HSCT needs to be
considered a serious contender. Graft-versus-host
disease (GVHD), both acute and chronic, remains
the major post-transplant cause of substantial nonrelapse
morbidity and mortality, is low in haplo-
HSCT. Trials increasingly show a dissociation
between GvHD and graft-versus-leukemia (GvL)
with comparable non-relapse mortality, overall and
relapse free survival in patients treated with a haplo-
HSCT. Composite outcome measures will rearrange
the weight of chronic GvHD.
Haplo-HSCT is increasingly considered the potential
standard of care for non-malignant but also for malignant indications worldwide, for good reasons.
In the end, the need of a cost-efficient, suitable donor
will drive the popularity of this transplant modality.
Key words: Leukemia,
Transplantation,
Haploidentical.
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