Haploidentical Family Donor Transplantation for Pediatric Hematologic Malignancies / 임상소아혈액종양

ABSTRACT

Haploidentical family donor hematopoietic stem cell transplantation (Haplo-HSCT) has been increasingly used for patients who require transplant for optimum therapy, but lack a human leukocyte antigen (HLA)-matched donor. Important variables that require consideration in choosing one of potentially many haplo-donors include evaluation for presence of donor-specific anti-HLA antibodies, the age and gender of the donor, the parental relationship of the donor especially for pediatric patients, and ABO compatibility. Three major platforms have been reported as valid methods of undertaking haplo-HSCT. Ex vivo T cell depleted transplant may allow for low rates of graft-versus-host disease, even without pharmacological prophylaxis after transplant. Major impediments such as delayed immune recovery and subsequent infections may be overcome by depletion of specific T cell subsets, as done in αβ T cell/B cell depleted transplants. Alternatively, T cell replete haplo-HSCT may be undertaken with post-transplantation cyclophosphamide, or by administering intensive pre- and post-transplant immunosuppression including use of anti-thymocyte globulin.All three haplo-HSCT platforms have been successfully used to treat children with hematologic malignancies. As this method of HSCT is relatively new, long-term follow-up is necessary to improve outcomes and clarify the toxicities of this transplant modality.