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Graft Failure and Rejection in Haploidentical Stem Cell Transplantation

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Haploidentical Stem Cell Transplantation

Part of the book series: Stem Cell Biology and Regenerative Medicine ((STEMCELL))

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Abstract

Haploidentical SCT is increasingly used for patients without a suitable HLA-identical sibling donor that requires an urgent transplantation. Graft failure (GF) is defined by the inability to achieve donor cell engraftment or donor graft loss after initial engraftment, and manifests with severe pancytopenia and marrow aplasia. GF can be mediated by cellular of humoral immunity. Other causes are infections, drugs, HLA and major ABO-mismatch, low cell dose in the graft, T-cell depletion, umbilical cord SCT, and reduced intensity conditioning regimens. The overall rate of GF in alloSCT is 5.6%. In haploSCT the rate is variable (0–27%) according to the graft source and content, conditioning regimen, T-cell depletion and GvHD prophylaxis. Despite the excellent results with modern techniques, graft rejection remains a potential complication in up to 10% of patients undergoing haploSCT with any approach, and is usually related to donor HLA-specific antibodies. There is no good quality evidence regarding the best treatment for graft failure, although performing a second transplant is the preferred approach. Infusion of hematopoietic growth factors and Mesenchymal stromal cells has also been used, but the prognosis remains challenging.

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  1. Hematology Department and BMT and Cell Therapy Unit, University Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain

    Miguel Blanquer & Jose M. Moraleda

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  2. Jose M. Moraleda
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    Taner Demirer

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Blanquer, M., Moraleda, J.M. (2017). Graft Failure and Rejection in Haploidentical Stem Cell Transplantation. In: Demirer, T. (eds) Haploidentical Stem Cell Transplantation. Stem Cell Biology and Regenerative Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-65319-8_3

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