[Haploidentical hematopoietic stem cell transplant: How to choose the best donor? Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)].

Greffe de cellules souches hématopoïétiques haplo-identiques avec cyclophosphamide en post-greffe : comment choisir le meilleur donneur en 2019 ? Recommandations de la Société francophone de greffe de mœlle et de thérapie cellulaire (SFGM-TC)

Valérie Dubois (1) , Kahina Amokrane (2) , Yves Beguin (3) , Benedicte Bruno (4) , Patrice Chevallier (5) , Florent Delbos (6) , Raynier Devillier (7) , Catherine Giannoli (8) , Gwendaline Guidicelli (9) , Mhamed Harif , Pascale Loiseau (10) , Paul-Olivier Rouzaire (11, 12) , Pauline Varlet (13, 14) , Ibrahim Yakoub-Agha (4, 14) , Stephanie Nguyen (15)

1 EFS - Etablissement français du sang - Auvergne-Rhône-Alpes
2 AP-HP - Hopital Saint-Louis [AP-HP]
3 Service d'Hématologie
4 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
5 CRCINA-ÉQUIPE 1 - Immunobiology of Human αβ and γδ T Cells and Immunotherapeutic Applications
6 Laboratoire d'Histocompatibilité et d'Immunogénétique [EFS Nantes]
7 CRCM - Centre de Recherche en Cancérologie de Marseille
8 Etablissement français du sang- Rhône-Alpes [Lyon]
9 Service d'immunologie et d'immunogénétique [Bordeaux]
10 Immunogénétique humaine
11 CHU Clermont-Ferrand
12 IMoST - Imagerie Moléculaire et Stratégies Théranostiques
13 CHU de Lille - Centre Hospitalier Universitaire de Lille
14 LIRIC - Lille Inflammation Research International Center - U 995
15 Department of Microbiology and Immunology

Haploidentical hematopoietic stem cell transplantation has been growing steadily since 2012. The SFGM-TC has twice published guidelines concerning T-cell repleted haploidentical grafts with high dose cyclophosphamide post-transplantation. The 2013 workshop recommended using the non-myeloablative Baltimore protocol with bone marrow and developed prospective protocols to evaluate these transplantations. The 2015 workshop reported improved results of reduced conditioning regimens in Hodgkin's lymphoma and intensive conditioning in myeloid hemopathies, and a similar outcome with 10/10 HLA matched donor with the same disease-risk score thus raising the question of the qualifier "alternative" for haploidentical transplants. The current work concerns the criteria for selecting the donor. The main criterion remains the absence of anti-HLA antibodies directed against the donor present in the recipient sera (DSA - Donor Specific Antibodies). In case of DSA and in the absence of an alternative donor, desensitization protocols exist. The other criteria are impossible to prioritize: age, sex, CMV, and blood type. The degree of relatedness and the number of HLA incompatibilities do not seem to be a criterion of choice. The 'ideal' donor would be a young man, CMV-matched, without major ABO incompatibility with a marrow transplant. There is insufficient data for the KIR-ligand and NIMA/NIPA mismatch. Peripheral stem cell grafts appear to yield more acute GVHD than bone marrow grafts after intensive conditioning, but with comparable survival rates. Based on the literature review, the comparison of haploidentical with unrelated donors encourages inclusion in existing national protocols randomizing these different donors.

Mots clés: Haploidentical transplantation; Donor choice; DSA; Choix du donneur; Greffe haplo-identique

Domaines: Sciences du Vivant [q-bio]; Cancer

Valérie Dubois, Kahina Amokrane, Yves Beguin, Benedicte Bruno, Patrice Chevallier, et al.. Greffe de cellules souches hématopoïétiques haplo-identiques avec cyclophosphamide en post-greffe : comment choisir le meilleur donneur en 2019 ? Recommandations de la Société francophone de greffe de mœlle et de thérapie cellulaire (SFGM-TC). Bulletin du Cancer, 2020, 107 (1), pp.S72-S84. ⟨10.1016/j.bulcan.2019.07.011⟩. ⟨hal-02887929⟩