Sociedad Argentina de Hematología

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Revista Argentina de Hematología


Volumen:    21    # Number : 1°er Cong. de Trasplante de Células Progenitoras Hematopoyéticas - 2°do Congreso del LABMT

Publication Date :    Marzo    Year:    2017


Is haploidentical HSCT for leukemias a valid alternative or still a second choice?

Authors: Corbacioglu S

Abstract: Pediatric acute lymphoblastic leukemia (ALL) has cure rates of over 90% in many developed countries and the relapse rates are continuously declining over the last decades. Ostensibly, this development leaves only few patients with an indication for an allogeneic hematopoietic stem cell transplantation (HSCT). But the increasing cure rates in children is accompanied by an exponentially rising curve of treatment related morbidity and mortality. In adult ALL the development is similar, but with cure rates roughly half those seen in children. Major advances in hematopoietic stem cell transplantation (HSCT) over the last decade have substantially decreased transplant-related morbidity and mortality. A major recent development in HSCT is the exponential use of haploidentical HSCT (haplo-HSCT) based on the ubiquitously availability of the post-transplant cyclophosphamide approach for low cost. Also, T-depleted haploidentical transplantation advanced clearly, so that haploidentical HSCT needs to be considered a serious contender. Graft-versus-host disease (GVHD), both acute and chronic, remains the major post-transplant cause of substantial nonrelapse morbidity and mortality, is low in haplo- HSCT. Trials increasingly show a dissociation between GvHD and graft-versus-leukemia (GvL) with comparable non-relapse mortality, overall and relapse free survival in patients treated with a haplo- HSCT. Composite outcome measures will rearrange the weight of chronic GvHD. Haplo-HSCT is increasingly considered the potential standard of care for non-malignant but also for malignant indications worldwide, for good reasons. In the end, the need of a cost-efficient, suitable donor will drive the popularity of this transplant modality.

Key words: Leukemia, Transplantation, Haploidentical.

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