Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation?
Background One major limitation for broader applicability of allogeneic hematopoietic cell transplantation (allo-HCT) in the past was the lack of HLA-matched histocompatible donors. Preclinical mouse studies using T-cell depleted haploidentical grafts led to an increased interest in the use of ex vi...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2024-12-01
|
| Series: | Hematology |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/16078454.2024.2326384 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846126623749832704 |
|---|---|
| author | Razan Mohty Zaid Al Kadhimi Mohamed Kharfan-Dabaja |
| author_facet | Razan Mohty Zaid Al Kadhimi Mohamed Kharfan-Dabaja |
| author_sort | Razan Mohty |
| collection | DOAJ |
| description | Background One major limitation for broader applicability of allogeneic hematopoietic cell transplantation (allo-HCT) in the past was the lack of HLA-matched histocompatible donors. Preclinical mouse studies using T-cell depleted haploidentical grafts led to an increased interest in the use of ex vivo T-cell depleted (TCD) haploidentical allo-HCT. TCD grafts through negative (T-cell depletion) or positive (CD34+ cell selection) techniques have been investigated to reduce the risk of graft-versus-host disease (GVHD) given the known implications of alloreactive T cells. A more practical approach to deplete alloreactive T cells in vivo using high doses of cyclophosphamide after allografting has proved to be feasible in overcoming the HLA barrier. Such approach has extended allo-HCT feasibility to patients for whom donors could not be found in the past. Nowadays, haploidentical donors represent a common donor source for patients in need of an allo-HCT. The broad application of haploidentical donors became possible by understanding the importance of depleting alloreactive donor T cells to facilitate engraftment and reduce incidence and severity of GVHD. These techniques involve ex vivo graft manipulation or in vivo utilization of pharmacologic agents, notably post-transplant cyclophosphamide (PTCy).Discussion While acknowledging that no randomized controlled prospective studies have been yet conducted comparing TCD versus PTCy in haploidentical allo-HCT recipients, there are two advantages that would favor the PTCy, namely ease of application and lower cost. However, emerging data on adverse events associated with PTCy including, but not limited to cardiac associated toxicities or increased incidence of post-allograft infections, and others, are important to recognize. |
| format | Article |
| id | doaj-art-0d5342cfd0f34d9eab336b1de19c2b48 |
| institution | Kabale University |
| issn | 1607-8454 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Hematology |
| spelling | doaj-art-0d5342cfd0f34d9eab336b1de19c2b482024-12-12T15:08:52ZengTaylor & Francis GroupHematology1607-84542024-12-0129110.1080/16078454.2024.2326384Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation?Razan Mohty0Zaid Al Kadhimi1Mohamed Kharfan-Dabaja2Division of Hematology Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USADivision of Hematology Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USADivision of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USABackground One major limitation for broader applicability of allogeneic hematopoietic cell transplantation (allo-HCT) in the past was the lack of HLA-matched histocompatible donors. Preclinical mouse studies using T-cell depleted haploidentical grafts led to an increased interest in the use of ex vivo T-cell depleted (TCD) haploidentical allo-HCT. TCD grafts through negative (T-cell depletion) or positive (CD34+ cell selection) techniques have been investigated to reduce the risk of graft-versus-host disease (GVHD) given the known implications of alloreactive T cells. A more practical approach to deplete alloreactive T cells in vivo using high doses of cyclophosphamide after allografting has proved to be feasible in overcoming the HLA barrier. Such approach has extended allo-HCT feasibility to patients for whom donors could not be found in the past. Nowadays, haploidentical donors represent a common donor source for patients in need of an allo-HCT. The broad application of haploidentical donors became possible by understanding the importance of depleting alloreactive donor T cells to facilitate engraftment and reduce incidence and severity of GVHD. These techniques involve ex vivo graft manipulation or in vivo utilization of pharmacologic agents, notably post-transplant cyclophosphamide (PTCy).Discussion While acknowledging that no randomized controlled prospective studies have been yet conducted comparing TCD versus PTCy in haploidentical allo-HCT recipients, there are two advantages that would favor the PTCy, namely ease of application and lower cost. However, emerging data on adverse events associated with PTCy including, but not limited to cardiac associated toxicities or increased incidence of post-allograft infections, and others, are important to recognize.https://www.tandfonline.com/doi/10.1080/16078454.2024.2326384Haploidentical transplantationpost-transplant cyclophosphamidecell selection |
| spellingShingle | Razan Mohty Zaid Al Kadhimi Mohamed Kharfan-Dabaja Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? Hematology Haploidentical transplantation post-transplant cyclophosphamide cell selection |
| title | Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? |
| title_full | Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? |
| title_fullStr | Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? |
| title_full_unstemmed | Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? |
| title_short | Post-transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation? |
| title_sort | post transplant cyclophosphamide or cell selection in haploidentical allogeneic hematopoietic cell transplantation |
| topic | Haploidentical transplantation post-transplant cyclophosphamide cell selection |
| url | https://www.tandfonline.com/doi/10.1080/16078454.2024.2326384 |
| work_keys_str_mv | AT razanmohty posttransplantcyclophosphamideorcellselectioninhaploidenticalallogeneichematopoieticcelltransplantation AT zaidalkadhimi posttransplantcyclophosphamideorcellselectioninhaploidenticalallogeneichematopoieticcelltransplantation AT mohamedkharfandabaja posttransplantcyclophosphamideorcellselectioninhaploidenticalallogeneichematopoieticcelltransplantation |