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Haploidentical Transplantation pp 145–157Cite as

Haploidentical Transplants and NK Cell Alloreactivity

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Abstract

Allogeneic hematopoietic cell transplantation is the most powerful form of immunotherapy for neoplastic hematological diseases as well as selected nonmalignant hematological disorders. Matching donor and recipient at HLA level is crucial for optimal transplant outcomes with acceptable non-relapse mortality. However, only 25% of individuals have an HLA-identical sibling who could serve as donor. Alternative hematopoietic graft sources are HLA-matched unrelated volunteers, unrelated umbilical cord blood units, and HLA haplotype-mismatched (“haploidentical”) family members which are, however, associated with up to 40% NRM due to diverse combinations of graft failure, GvHD, hepatic sinusoidal obstruction syndrome, and infections. Donor-versus-recipient NK cell alloreactivity is now established as a key therapeutic element in T-cell-depleted haploidentical hematopoietic transplantation for acute myeloid leukemia. Under T-cell-replete protocols, the benefits of NK cell alloreactivity might be expected to be antagonized/obscured as was reported in unrelated donor and cord blood transplantation. The only exception so far documented is the haploidentical hematopoietic cell transplant trial with Treg/Tcon add-backs that, however, do not use any posttransplant pharmacologic immunosuppressive GvHD prophylaxis. In this chapter we will discuss the various methods used in studies to augment NK cell alloreactivity in haploidentical transplantation.

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Author information

Authors and Affiliations

  1. Blood and Marrow Transplant Program, University of Perugia, Perugia, Italy

    Andrea Velardi

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  1. Andrea Velardi
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Correspondence to Andrea Velardi .

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Editors and Affiliations

  1. Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas, USA

    Stefan O. Ciurea

  2. Department of General Pediatrics and Hematology/Oncology, University Children’s Hospital, Tübingen, Baden-Württemberg, Germany

    Rupert Handgretinger

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Velardi, A. (2018). Haploidentical Transplants and NK Cell Alloreactivity. In: Ciurea, S., Handgretinger, R. (eds) Haploidentical Transplantation. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-54310-9_10

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  • DOI: https://doi.org/10.1007/978-3-319-54310-9_10

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