Hematopoietic stem cell transplantation from full-haplotype mismatched donors

Until a decade ago, hematopoietic stem cell transplantation from related donor mismatched at two or three HLA-A, -B or DR loci was largely unsuccessful in leukemia patients because of severe graft-versus-host disease in unmanipulated bone marrow transplants and graft failure in extensively T-cell-depleted transplants. The breakthrough came with the use of a megadose of T-cell-depleted hematopoietic progenitor cells. Donor-vs-recipient natural killer cell alloreactivity also plays a role in facilitating engraftment and in preventing relapse of acute myeloid leukemia. Event-free survival and transplant-related mortality for high risk acute leukemia patients treated at less advanced stages of disease compare favourably with reports from unrelated matched transplants. (C) 2002 Elsevier Science Ltd. All rights reserved.