Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.
Blood. 2011 Dec 1;118(23):6006-17. doi: 10.1182/blood-2011-07-338822. Epub 2011 Sep 14.
For patients with hematologic malignancies at high risk of relapse who do not have matched donors, a suitable alternative stem cell source is the HLA-haploidentical 2 or 3-loci mismatched family donor who is readily available for nearly all patients. Transplantation across the major HLA barrier is associated with strong T-cell alloreactions, which were originally manifested as a high incidence of severe GVHD and graft rejection. The present review shows how these obstacles to successful transplantation were overcome in the last 15 years, making full haplotype-mismatched transplantation a clinical reality that provides similar outcomes to transplantation from matched unrelated donors. The review also discusses the advantages and drawbacks of current options for full haplotype-mismatched transplantation and highlights innovative approaches for re-building immunity after transplantation and improving survival.
对于没有匹配供体的、有高复发风险的血液系统恶性肿瘤患者，如果有合适的替代干细胞来源，那么 HLA 单倍体不合的 2 或 3 个位点错配的家族供者是几乎所有患者都能获得的一个选择。跨越主要 HLA 障碍的移植会导致强烈的 T 细胞同种异体反应，最初表现为严重的移植物抗宿主病和移植物排斥反应发生率高。本综述展示了在过去 15 年中如何克服这些成功移植的障碍，使完全单倍体不合移植成为临床现实，提供与来自匹配无关供者的移植相似的结果。该综述还讨论了目前完全单倍体不合移植的选择的优缺点，并强调了移植后重建免疫和提高存活率的创新方法。
