ALLOGENEIC TRANSPLANTATION ACROSS THE HLA BARRIERS

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Abstract
In high‐risk acute leukemia patients, a 10‐fold increase in the dose of extensively T‐cell‐depleted hematopoietic stem cells ensures sustained full‐donor engraftment of one‐haplotype‐mismatched transplants without graft‐vs.‐host disease. Since our first successful pilot study, which exploited the principle of a megadose stem cell transplant, our efforts have concentrated on developing new conditioning regimens, optimizing graft processing and improving the post‐transplant immunologic recovery. The results so far achieved in more than 100 high‐risk acute leukemia patients show that haploidentical transplantation is now a clinical reality. Because virtually all patients in need of a hematopoietic stem cell transplant have a full‐haplotype‐mismatched family donor, a T‐cell‐depleted mismatched transplant can be offered with curative intent, thus extending allogeneic transplantation procedures to virtually all candidates.