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New Approaches to Allogeneic Hematopoietic Cell Transplantation
Abstract:
Overview
Allogeneic hematopoietic cell transplantation is a potentially curative therapeutic option for all hematologic malignancies. It is a double-edged sword that may result in significant mortality and morbidity. In recent years, there are ground-breaking advances in more availability of stem cell sources, emerging strategies for choosing the best donor, graft versus host disease (GVHD) prevention and treatment strategies as well as supportive care. Ultra-high resolution (UHR) using next-generation sequencing technology has been introduced to get more information that is sensitive on HLA typing possible to access the best-matched donors. Functional HLA matching with TCE3 and TCE4 and a scoring system named by “delta functional distance” (ΔFD) may help to GVL-GVHD counterbalance to the GVL direction. More effective GVHD prophylaxis (post-transplant cyclophosphamide and ATG) make it possible to reach broader donor diversity in terms of unrelated and haploidentical setting. Ex-vivo stem cell expansion with numerous small molecules (stem regenin 1, TAT-BMI1, nicotinamide, valproic acid) can improve engraftment and immune reconstitution rates in UCBT. Ruxolitinib, ibrutinib, vedolizumab, alpha-1 antitrypsin (AAT) and, mesenchymal stromal cells have promising results in the treatment of acute and chronic GVHD settings. Letermovir and maribavir have also encouraging results in CMV reactivation prophylaxis. This article summarizes the current state of art and paradigm shifts in allo-HCT.
Keywords
Allogeneic hematopoietic cell transplantation, GVHD, HLA typing, conditioning regimen, stem cell source
Article:
Article Information:
Disclosure
Cemaleddin Ozturk and Sinem Civriz Bozdag have no financial or non-financial relationships or activities to declare in relation to this article.
Compliance With Ethics
This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.
Review Process
Double-blind peer review.
Authorship
Both named authors meet the criteria of the International Committee of Medical Journal Editors (ICMJE) for authorship for this manuscript, take responsibility for the integrity of the work as a whole and have given final approval for the version to be published.
Correspondence
Cemaleddin Ozturk, MD, Department of Hematology Ankara University, Balkiraz Mah. Mamak Cd. No:12, 06620 Mamak/Ankara TURKEY
E: cemaleddinozturk@gmail.com
Twitter: @cemaleddinoztrk
Linkedin: linkedin.com/in/cemaleddin-öztürk-58715350
ORCÄ°D: 0000-0003-1591-6575
Support
No funding was received in the publication of this article.
Access
This article is freely accessible at touchONCOLOGY.com © Touch Medical Media 2020.
Received
2020-06-02
