Cell Manipulation in Pediatric Haploidentical Stem Cell Transplantation: State of the Art

Haploidentical transplantation in children can extend the opportunity for transplantation to almost every patient lacking a human leukocyte antigen (HLA)–matched donor and offer this treatment to every child with an otherwise incurable disease. Although initial attempts were associated with a high transplant-related mortality, recent insights into the biology of haploidentical transplantation, the availability of effective ex vivo large-scale graft-manipulation technology, and improved supportive care strategies have led to significantly better outcomes. Concurrently, the indication for haploidentical transplantation has been extended, including different malignant and nonmalignant conditions. Worldwide donor registries include mainly donors of Caucasian origin. Patients of non-Caucasian origin have a lower chance of finding a suitable unrelated donor. Haploidentical transplantation allows the treatment of children independently of their ethnic background in a timely fashion. One of the major advantages of using a related donor is the possibility of collecting or generating additional cellular products from the same donor to open the possibility of enhancing both the antitumor effects of the graft and the immunologic reconstitution after transplantation.