Spitzer Thomas R
Massachusetts General Hospital, Harvard University, 14 Seten Circle, Andover, MA 01810, USA.
Hematology Am Soc Hematol Educ Program. 2005:390-5. doi: 10.1182/asheducation-2005.1.390.
Haploidentical stem cell transplantation is a treatment option for the approximately 70% of patients who do not have an HLA-identical sibling donor. The availability of a haploidentical donor in most families is a potential advantage, both for avoiding the need to find an alternative unrelated donor, and for the potentially more potent graft-versus-tumor effect that can be induced. The early complications of severe graft-versus-host disease (GVHD) following T-cell replete stem cell transplantation (SCT), and graft failure and recurrent malignancy (after T-cell depleted SCT) have limited the applications of this approach. Newer strategies employing T-cell depletion of the graft, using either very high-dose peripheral blood stem cells and/or more intensive conditioning therapy have overcome some of the problems of conventional transplantation. Nonmyeloablative SCT approaches have overcome some of the morbidity and mortality associated with the early complications of SCT and have been associated with favorable engraftment and GVHD profiles. Induction of mixed lymphohematopoietic chimerism as a platform for adoptive cellular immunotherapy (via delayed donor lymphocyte infusions) may have important application in avoiding early GVHD, while ultimately capturing a very potent graft-versus-tumor effect. Current strategies are focusing on improvement of immune reconstitution and prevention of recurrence of the underlying malignancy.
单倍体相合干细胞移植是约70%没有人类白细胞抗原（HLA）相合同胞供者的患者的一种治疗选择。大多数家庭中存在单倍体相合供者是一个潜在优势，既避免了寻找替代无关供者的需求，也因为可能诱导出更强的移植物抗肿瘤效应。T细胞充足的干细胞移植（SCT）后严重移植物抗宿主病（GVHD）的早期并发症，以及移植物失败和复发恶性肿瘤（T细胞去除的SCT后）限制了这种方法的应用。采用移植物T细胞去除的新策略，使用非常高剂量的外周血干细胞和/或更强化的预处理疗法，克服了传统移植的一些问题。非清髓性SCT方法克服了与SCT早期并发症相关的一些发病率和死亡率，并与良好的植入和GVHD情况相关。诱导混合淋巴细胞造血嵌合体作为过继性细胞免疫治疗（通过延迟供者淋巴细胞输注）的平台，在避免早期GVHD方面可能有重要应用，同时最终获得非常强的移植物抗肿瘤效应。当前策略专注于改善免疫重建和预防潜在恶性肿瘤的复发。
