Haploidentical Transplantation Using Unmanipulated G-CSF-Primed Blood and Marrow as Allografts: Clinical Data and Challenges

Chapter
Part of the Advances and Controversies in Hematopoietic Transplantation and Cell Therapy book series (ACHTCT)

Abstract

Haploidentical hematopoietic cell transplantation (haplo-HCT) is available for nearly all patients, with no search or acquisition costs to the patient. However, successful use of haplo-HCT has been hampered by T-cell alloreactivity, due to differences in human leukocyte antigen (HLA) loci on an unshared chromosome 6. Novel approaches to overcome these barriers require expensive laboratory facilities and well-trained staff with high expertise in cell manipulation and are not widely applicable to most transplant centers. Over the last 10 years, based on immune tolerance induced by granulocyte colony-stimulating factor (G-CSF) and antithymocyte globulin (ATG), the Peking University groups established a protocol for unmanipulated haplo-HCT using myeloablative conditioning (MAC) regimen using G-CSF-primed bone marrow (G-BM) and peripheral blood (G-PB) hematopoietic CD34+ cell grafts. A series of studies demonstrated that unmanipulated G-CSF-stimulated haploidentical grafts can lead to rapid immune recovery, desirable health-related quality of life (QoL), and a survival rate comparable to that following HLA-matched sibling donor hematopoietic cell transplant (MSD-HCT) or HLA-matched unrelated donor hematopoietic cell transplant (MUD-HCT). This chapter begins with an overview of immunoregulatory effects of G-CSF on graft composition, followed by a presentation of clinical results after unmanipulated haplo-HCT with ATG preparative regimen using G-BM and/or G-PB as allografts. Thereafter, strategies on improvement of the abovementioned transplant modalities are discussed.

Keywords

Haploidentical transplantation G-CSF-primed transplants T-cell alloreactivity Immune tolerance 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People’s HospitalPeking University Institute of HematologyBeijingChina

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