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.