PMID- 17950913
OWN - NLM
STAT- MEDLINE
DCOM- 20071211
LR  - 20071022
IS  - 1083-8791 (Print)
IS  - 1083-8791 (Linking)
VI  - 13
IP  - 11
DP  - 2007 Nov
TI  - Allogeneic hematopoietic stem cell transplant using mismatched/haploidentical 
      donors.
PG  - 1249-67
AB  - Haploidentical hematopoietic stem cell transplantation (HSCT) provides an 
      opportunity for nearly all patients to benefit from HSCT when a human leukocyte 
      antigen (HLA) genotypically matched sibling is not available. Initial results 
      with the use of mismatched allografts led to limited enthusiasm because of 
      graft-versus-host disease (GVHD) and infectious complications, resulting in an 
      unacceptable treatment-related morbidity and mortality. Recent advances with 
      effective T cell depletion, the use of a "megadose" of stem cells, earlier 
      detection of severe infections, combined with better antimicrobial therapy and 
      reduced-intensity conditioning (RIC) has significantly decreased the early 
      transplant-related mortality and GVHD, whereas enabling prompt engraftment, hence 
      advancing the therapeutic benefit of haploidentical transplantation. However, the 
      cardinal problems related to delayed immune reconstitution allowing 
      posttransplant infectious complications and relapse remain, limiting the efficacy 
      of haploidentical HSCT. Preliminary data has demonstrated the potential for use 
      of adoptive cellular immunity and selective allodepletion in rapidly 
      reconstituting immunity without GVHD. The encouraging reports from haploidentical 
      transplant using noninherited maternal antigen (NIMA)-mismatched or natural 
      killer (NK) alloreactive donors may greatly increase the donor availability and 
      open the way to more appropriate donor selection in HLA-haploidentical HSCT. 
      Future challenges remain in determining the safest approach for haploidentical 
      transplant to be performed with minimal risk of GVHD, whereas preserving 
      effective graft-versus-leukemia activity and promoting prompt immune 
      reconstitution.
FAU - Koh, Liang-Piu
AU  - Koh LP
AD  - Adult Bone Marrow and Stem Cell Transplantation Program, Duke University Medical 
      Center, Durham, North Carolina 27710, USA.
FAU - Rizzieri, David A
AU  - Rizzieri DA
FAU - Chao, Nelson J
AU  - Chao NJ
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Biol Blood Marrow Transplant
JT  - Biology of blood and marrow transplantation : journal of the American Society for 
      Blood and Marrow Transplantation
JID - 9600628
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Graft Survival/*immunology
MH  - HLA Antigens/immunology
MH  - Haplotypes
MH  - Hematopoietic Stem Cell Transplantation/*methods
MH  - Humans
MH  - Lymphocyte Depletion/*methods
MH  - Transplantation Conditioning/methods
MH  - Transplantation Tolerance/immunology
MH  - Transplantation, Homologous/immunology
RF  - 113
EDAT- 2007/10/24 09:00
MHDA- 2007/12/12 09:00
CRDT- 2007/10/24 09:00
PHST- 2007/07/02 00:00 [received]
PHST- 2007/08/13 00:00 [accepted]
PHST- 2007/10/24 09:00 [pubmed]
PHST- 2007/12/12 09:00 [medline]
PHST- 2007/10/24 09:00 [entrez]
AID - S1083-8791(07)00383-7 [pii]
AID - 10.1016/j.bbmt.2007.08.003 [doi]
PST - ppublish
SO  - Biol Blood Marrow Transplant. 2007 Nov;13(11):1249-67. doi: 
      10.1016/j.bbmt.2007.08.003.