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Myeloablative Versus Nonmyeloablative Conditioning Regimen in Haploidentical Transplantation: Does It Matter and How Best to Select Between the Two?

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Haploidentical Transplantation

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Abstract

We review the role of conditioning regimens in patients undergoing an allogeneic hematopoietic cell transplantation (HCT) from HLA-haploidentical family donors. As with other types of transplants, the effect of the regimen intensity cannot be entirely dissected from other important components of a haploidentical transplant such as graft composition, graft source, immunosuppression, etc., all of which influence transplant outcomes. In general transplant programs involving ex vivo T-cell depletion (TCD) use myeloablative conditioning (MAC) regimens, whereas nonmyeloablative (NMA) regimens are used for both ex vivo and in vivo TCD. NMA regimens are associated with a low risk of graft-versus-host disease (GvHD) and non-relapse mortality (NRM), with higher risk of relapse compared to MAC regimens. MAC regimens are required for most young patients with acute leukemias, or aggressive disease. Currently the combination of different alkylating agents, such as busulfan (Bu) and thiotepa or Bu and melphalan (Mel), can achieve significant disease control, with acceptable toxicity. In a nutshell, the intensity of the conditioning regimen does matter and represents an important part of the haploidentical hematopoietic cell transplantation (haplo-HCT).

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  1. Istituto di Ematologia e Trapianto di Midollo Osseo, Policlinico Gemelli, Universita’ Cattolica, Roma, Italy

    Andrea Bacigalupo, Patrizia Chiusolo & Simona Sica

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  1. Andrea Bacigalupo
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  2. Patrizia Chiusolo
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Correspondence to Andrea Bacigalupo .

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Editors and Affiliations

  1. Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas, USA

    Stefan O. Ciurea

  2. Department of General Pediatrics and Hematology/Oncology, University Children’s Hospital, Tübingen, Baden-Württemberg, Germany

    Rupert Handgretinger

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Bacigalupo, A., Chiusolo, P., Sica, S. (2018). Myeloablative Versus Nonmyeloablative Conditioning Regimen in Haploidentical Transplantation: Does It Matter and How Best to Select Between the Two?. In: Ciurea, S., Handgretinger, R. (eds) Haploidentical Transplantation. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-54310-9_11

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