Allogeneic Transplantation in Pediatric Patients with Hematologic Malignancies

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Background

Allogeneic transplantation still remains the standard of care for patients with high-risk hematological malignancies at diagnosis or after relapsing disease. However, GvHD remains the most relevant clinical complication in the early post-transplant period. New clinical and technical approaches such as T-cell depletion, the use of cyclophosphamide as GvHD prophylaxis, or wider use of alternative donors, have provided an opportunity for transplant to patients needing an allogeneic transplant in a timely manner.

The use of alternative donors such as unrelated, haploidentical donors and cord blood units have have expanded the use of allogeneic transplants to patients lacking a matched sibling donor. Moreover, new technology of T-cell depletion and new approaches to GvHD prevention have reduced or minimized severe GvHD while preserving GvL effect. These technologies have changed the perspective of allogeneic transplant being considered a platform for cellular therapies rather than an ultimate treatment. Post-transplant cell therapies are based on the use of either NK-cells or some subset of T-cells such as regulatory T-cells or memory T-cells. Currently, the rapid development of graft manipulation techniques allows clinicians the development of new transplant and post-transplant strategies in order to improve transplant outcomes.

The present Research Topic is focused on the use of alternative donors in allogeneic transplant settings in children with hematologic malignancies. The scope includes not only the use of cord blood units, unrelated or haploidentical donors but also the use of new technologies for T-cell depletion or new clinical GvHD prevention approaches. We also welcome papers focused on post-transplant cellular therapies.

Keywords: haploidentical transplantation, childhood leukemias, GvL/GvT effect, donor lymphocyte infusions, NK cells, memory T-cells, naive T-cells, T-cell depletion, graft manipulation techniques

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