Haplo-SCT vs CBT: advantages and disadvantages
Donor . | CBT . | HAPLO-transplant . | ||
---|---|---|---|---|
SCBT . | DCBT . | TCD . | TCR . | |
Indications | Nonmalignant and malignant | Nonmalignant and malignant | Mainly malignant | Mainly malignant |
Age | Mainly pediatric | Adult and pediatric | Adult and pediatric | Adult and pediatric |
Donor availability | High | High | High | High |
Degree of HLA mismatch | 1-2 mismatches | 1-2 mismatches | 2-3 mismatches | 2-3 mismatches |
DSA | Important | Important | Important | Important |
Time for donor identification | Slower <1 month | Slower compared to SCBT | Faster (immediate) | Faster (immediate) |
Time of graft acquisition | 15-30 days | 15-30 days | 15-30 days | 15-30 days |
Type of graft | Cryopreserved CBU | 2 cryopreserved CBUs | Mobilized PB | Mobilized PB and/or BM |
Limitation of graft acquisition | Cell dose | Improved compared to SCBT | Poor mobilization | Improved compared to TCD haplo |
Graft manipulation | Ex vivo expansion | None | In vivo TCD | None |
Donor safety (risk to the donor) | No risk | No risk | Very low | Very low |
Easy to repeat stem cell donation | Not possible | Not possible | Possible | Possible |
Conditioning | MAC and RIC | MAC and RIC | MAC | MAC and RIC |
Engraftment | Delayed | Improvement compared to SCBT | Comparable to MRD or MUD | Comparable to MRD or MUD |
Use of ATG | Determinantal omitted | Determinantal omitted | Indicated (can be replaced by PTCy) | Indicated (can be replaced by PTCy) |
GVHD | Lower incidence with less stringent HLA matching needed | Incidence increased compared to SCBT | Low incidence | Low incidence with BM and PTCy; higher incidence with PB |
NRM | High due to graft failure and infections | Improved compared to SCBT | High | Improved compared to TCD-haplo |
RI | Comparable to MSD or MUD | Low compared to SCBT | High | Comparable to MSD or MUD (higher in initial report) with BM and RIC |
DLI | Not possible | Not possible | Possible | Possible |
Immune reconstitution | Slow | Improved compared to SCBT | Slow | Improved compared to TCD-haplo |
Infections incidence | High | Improved compared to SCBT | High | Improved compared to TCD-Haplo |
OS | Lower than other stem cell sources | Improved compared to SCBT | Lower than other stem cell sources | Improved compared to TCD-Haplo |
Cost associated with donor search and graft procurement | High | Very high | Lower | Lower |
Donor . | CBT . | HAPLO-transplant . | ||
---|---|---|---|---|
SCBT . | DCBT . | TCD . | TCR . | |
Indications | Nonmalignant and malignant | Nonmalignant and malignant | Mainly malignant | Mainly malignant |
Age | Mainly pediatric | Adult and pediatric | Adult and pediatric | Adult and pediatric |
Donor availability | High | High | High | High |
Degree of HLA mismatch | 1-2 mismatches | 1-2 mismatches | 2-3 mismatches | 2-3 mismatches |
DSA | Important | Important | Important | Important |
Time for donor identification | Slower <1 month | Slower compared to SCBT | Faster (immediate) | Faster (immediate) |
Time of graft acquisition | 15-30 days | 15-30 days | 15-30 days | 15-30 days |
Type of graft | Cryopreserved CBU | 2 cryopreserved CBUs | Mobilized PB | Mobilized PB and/or BM |
Limitation of graft acquisition | Cell dose | Improved compared to SCBT | Poor mobilization | Improved compared to TCD haplo |
Graft manipulation | Ex vivo expansion | None | In vivo TCD | None |
Donor safety (risk to the donor) | No risk | No risk | Very low | Very low |
Easy to repeat stem cell donation | Not possible | Not possible | Possible | Possible |
Conditioning | MAC and RIC | MAC and RIC | MAC | MAC and RIC |
Engraftment | Delayed | Improvement compared to SCBT | Comparable to MRD or MUD | Comparable to MRD or MUD |
Use of ATG | Determinantal omitted | Determinantal omitted | Indicated (can be replaced by PTCy) | Indicated (can be replaced by PTCy) |
GVHD | Lower incidence with less stringent HLA matching needed | Incidence increased compared to SCBT | Low incidence | Low incidence with BM and PTCy; higher incidence with PB |
NRM | High due to graft failure and infections | Improved compared to SCBT | High | Improved compared to TCD-haplo |
RI | Comparable to MSD or MUD | Low compared to SCBT | High | Comparable to MSD or MUD (higher in initial report) with BM and RIC |
DLI | Not possible | Not possible | Possible | Possible |
Immune reconstitution | Slow | Improved compared to SCBT | Slow | Improved compared to TCD-haplo |
Infections incidence | High | Improved compared to SCBT | High | Improved compared to TCD-Haplo |
OS | Lower than other stem cell sources | Improved compared to SCBT | Lower than other stem cell sources | Improved compared to TCD-Haplo |
Cost associated with donor search and graft procurement | High | Very high | Lower | Lower |
SCBT, single cord blood transplantation; TCD, T-cell depletion; TCR, T-cell repletion.