Current status of GVHD control in HLA mismatched stem cell transplantation from family donor

Abstract

To date, a variety of HLA-mismatched (haploidentical, haplo) stem cell transplantation regimens have been reported. The three most common regimens outside of Japan involve 1) ex vivo T cell depletion, 2) high dose anti-thymocyte globulin, and 3) post-transplant cyclophosphamide. According to reports, GVHD is sufficiently controlled, and each regimen could be considered a standard therapy. The magnitude of graft-versus leukemia/lymphoma (GVL) effect in each haplo regimen, however, remains unclear. All of these three regimens are generally used to target patients in complete remission (CR), In Japan, on the other hand, haplo transplants tend to be used for patients not achieving CR or in post-transplant relapse. In the haplo regimen employed at our institute, we have utilized chemokine blockage with steroid-containing GVHD prophylaxis. There are many opportunities to test various GVHD therapies for severe GVHD in haplo transplantation. In this review, I will discuss our experience with thymoglobulin, mycophenolate mofetil, infliximab, oral beclomethasone dipropionate, and mesenchymal stem cells M.