Haploidentical transplantation: An optimal platform for graft manipulation and cellular therapies

IF 6.9 2区医学 Q1 HEMATOLOGY

Blood Reviews Pub Date : 2025-03-21 DOI:10.1016/j.blre.2025.101286

C.C. Astigarraga , Klauberg MPMS , L. Iovino , F. Milano

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引用次数: 0

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains a curative therapeutic option for patients with high-risk hematologic malignancies. When a fully matched donor is unavailable, haploidentical hematopoietic stem cell transplantation (haplo-HCT) provides a viable alternative. Over time, haplo-HCT procedures have significantly evolved, improving outcomes in treatment related mortality (TRM), especially in graft-versus-host disease (GvHD). However, challenges such as delayed immune reconstitution and disease relapse persist. Advances in in vivo graft manipulation techniques, such as post-transplant cyclophosphamide (PTCy) and ex vivo approaches, including TCRα/β and CD19 depletion, have shown promise in reducing the risk of severe GvHD without increasing the relapse rates. Innovative strategies, such as haploidentical donor lymphocyte infusions, “suicide-switch” mechanisms, ORCA-Q product infusions, and CAR based therapies offer potential to further optimize outcomes. This review examines the graft manipulation modalities in the haplo-HCT setting, highlighting their role in advancing cellular therapies and providing new hope in the fight against life-threatening diseases.

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单倍体移植：移植操作和细胞治疗的最佳平台。

同种异体造血干细胞移植（allogene hematopoietic stem cell transplantation, alloo - hct）仍然是治疗高危恶性血液病的有效选择。当没有完全匹配的供体时，单倍体造血干细胞移植（haploo - hct）提供了一个可行的选择。随着时间的推移，单倍hct技术已经显著发展，改善了治疗相关死亡率（TRM）的结果，特别是在移植物抗宿主病（GvHD）中。然而，免疫重建延迟和疾病复发等挑战仍然存在。体内移植操作技术的进展，如移植后环磷酰胺（PTCy）和体外方法，包括TCRα/β和CD19去除，已经显示出在不增加复发率的情况下降低严重GvHD风险的希望。创新策略，如单倍体供体淋巴细胞输注、“自杀开关”机制、ORCA-Q产品输注和基于CAR的疗法，提供了进一步优化结果的潜力。本文综述了单倍hct环境下的移植物操作方式，强调了它们在推进细胞治疗方面的作用，并为对抗危及生命的疾病提供了新的希望。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Reviews 医学-血液学

CiteScore

13.80

自引率

1.40%

发文量

期刊介绍： Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.