- Franco Aversa: Hematopoietic Stem Cell Transplantation Program, Section of Hematology, Department of Internal and Experimental Medicine, University of Perugia, Italy. aversa@unipg.it
BACKGROUND AND OBJECTIVES: Clinical outcome in leukemia patients transplanted from one-haplotype mismatched donors has been largely disappointing because of the high incidence of severe graft-vs-host disease in T-replete transplants or high rejection rates in T-cell-depleted transplants.
EVIDENCE AND INFORMATION SOURCES: The breakthrough came with the use of a megadose of T-cell-depleted progenitor cells after a high intensity conditioning regimen.
STATE OF ART: Today, high risk acute leukemia patients are treated at less advanced stages of disease, receive a well-tolerated conditioning regimen, and benefit from advances in post-transplant immunologic reconstitution. Overall, event-free survival and transplant-related mortality compare favorably with those reported for unrelated matched transplants.
PERSPECTIVES: T-cell depleted megadose stem cell transplant from a mismatched family member, who is immediately available, can be offered as a viable option to candidates with high-risk acute leukemias.