
Contents
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History of stem-cell transplantation History of stem-cell transplantation
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The incipit The incipit
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Recent developments Recent developments
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Donor type Donor type
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The human leukocyte antigen barrier The human leukocyte antigen barrier
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Donor and patient registries Donor and patient registries
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Human leukocyte antigen typing Human leukocyte antigen typing
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Cord-blood matching Cord-blood matching
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Donor selection Donor selection
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Human leukocyte antigen compatibility Human leukocyte antigen compatibility
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Donor-related issues Donor-related issues
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Hierarchy Hierarchy
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Haploidentical transplant: history and recent development Haploidentical transplant: history and recent development
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Unmanipulated bone marrow Unmanipulated bone marrow
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Ex vivo T-cell depletion Ex vivo T-cell depletion
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CD34+ positive selection CD34+ positive selection
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CD34+ negative selection CD34+ negative selection
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TCRαβ depletion TCRαβ depletion
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In vivo T-cell depletion In vivo T-cell depletion
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Post-transplant cyclophosphamide Post-transplant cyclophosphamide
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Summary Summary
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Stem-cell source Stem-cell source
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Bone marrow Bone marrow
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Peripheral blood Peripheral blood
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Haploidentical setting Haploidentical setting
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Impact of stem-cell source on graft-versus-host disease and relapse Impact of stem-cell source on graft-versus-host disease and relapse
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T-cell replete haploidentical graft T-cell replete haploidentical graft
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Cord blood Cord blood
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Minor sibling donors Minor sibling donors
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Conditioning regimens Conditioning regimens
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The struggle to reduce the use of radiotherapy in children The struggle to reduce the use of radiotherapy in children
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Acute myeloid leukaemia Acute myeloid leukaemia
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Acute lymphoblastic leukaemia Acute lymphoblastic leukaemia
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Reduced-intensity conditioning to reduce toxicity post stem-cell transplantation Reduced-intensity conditioning to reduce toxicity post stem-cell transplantation
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Reduced-intensity versus myeloablative conditioning in paediatric acute myeloid leukaemia Reduced-intensity versus myeloablative conditioning in paediatric acute myeloid leukaemia
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Reduced-intensity versus myeloablative conditioning regimen in acute lymphoblastic leukaemia Reduced-intensity versus myeloablative conditioning regimen in acute lymphoblastic leukaemia
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Indications for stem-cell transplantation Indications for stem-cell transplantation
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Acute lymphoblastic leukaemia Acute lymphoblastic leukaemia
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Haematopoietic stem-cell transplantation in first complete remission Haematopoietic stem-cell transplantation in first complete remission
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The t(9;22) translocation The t(9;22) translocation
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Infants Infants
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Haematopoietic stem-cell transplantation in second complete remission Haematopoietic stem-cell transplantation in second complete remission
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Donor type according to patient risk profile Donor type according to patient risk profile
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Outcome according to minimal residual disease at haematopoietic stem-cell transplantation Outcome according to minimal residual disease at haematopoietic stem-cell transplantation
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Relapse after transplant Relapse after transplant
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Acute myeloid leukaemia Acute myeloid leukaemia
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Solid tumours Solid tumours
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Strategies to exploit the graft-versus-tumour effect in solid tumours Strategies to exploit the graft-versus-tumour effect in solid tumours
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Post-transplant immunotherapy Post-transplant immunotherapy
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Importance of long-term follow-up Importance of long-term follow-up
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Further reading Further reading
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7 C7Allogeneic Stem-Cell Transplantation in Children and Adolescents with Malignancies
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Published:September 2020
Cite
Abstract
Allogeneic haematopoietic stem-cell transplantation (HSCT) is of benefit for children and adolescents affected with malignancies which are refractory to conventional chemotherapy. Since the first HSCT took place in 1957 and human leukocyte antigen (HLA) genetics were unravelled, thousands of patients have been virtually cured from their disease after undergoing HSCT. Eligibility criteria, donor selection, stem-cell source, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, and supportive therapy evolved over time and contributed to the reduction in transplant-related mortality. In this chapter, alternative donors are mentioned and the excursus which led to ongoing haploidentical HSCT approaches are detailed. Issues related to HSCT in acute lymphoblastic leukaemia (ALL) (the most frequent indication for HSCT in paediatrics), acute myeloid leukaemia, and solid tumours are discussed. The impact of minimal residual disease on HSCT outcome in ALL, strategies to exploit the graft-versus-tumour effect in solid tumours, and post-HSCT immunotherapy are highlighted.
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