Greffe de cellules-souches hématopoïétiques haplo-identiques dans le traitement des hémopathies malignes en pédiatrie (SFGM-TC)

Abstract

The use of haploidentical Hematopoietic Stem Cell Transplants (Haplo-HSCT) in adults has increased due to improved procedures that lower the risk of graft-versus-host disease (GvHD) and Transplant-Related Mortality (TRM). In pediatrics, haploidentical transplants, whether performed with in vivo or in vitro T-cell depletion, are considered an alternative to conventional transplants from genoidentical or phenoidentical donors with bone marrow (BM), peripheral stem cell (PBSC). This review synthesizes current knowledge, highlighting a thorough analysis of pediatric data from Haplo-HSCT for malignancies. In brief, donor selection criteria are the same as those published for adults, and the conditioning used is primarily myeloablative. The incidence of severe GvHD is lower as compared to adults, but other complications, such as hemorrhagic cystitis, veno-occusive disease and cardiac toxicity are present, and long-term follow-up data is lacking. We provide comprehensive recommendations for transplant preparation in treating pediatric AML and ALL, focusing on the "in vivo" T-cell depletion approach with high-dose post-transplant cyclophosphamide (PT-Cy).