Tcell depleted stem cell products

T-cell depletion of stem cell products can effectively reduce GVHD, but was found to be associated with an increased relapse rate due to the loss of a GVL effect.79'80 However, as noted previously, rigorous T-cell depletion/CD34+ enrichment has been successful in related, haplotype mismatched donor transplants, particularly when the HLA mismatch prevents KIR inhibition of donor NK cells.48 49 50 This might also apply to unrelated donors, but conflicting indications have so far been reported.92-95 Another approach may be to transplant T-depleted donor stem cells and then at a later date infuse reserved donor T cells when the patient hematopoietic system has been replaced.130 The intent being to avoid the massive initial stimulation of donor T cells by patient hematopoietic cells ("cytokine storm") that may promote GVHD, but recovering a GVL effect at a later point.

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