Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Update of the “Beijing Protocol” haplo-identical hematopoietic stem cell transplantation

Abstract

As one of the three successful approaches for haplo-identical stem cell transplantation (haplo-SCT) in recent decades, “Beijing protocol” was based on immune tolerance induced by granulocyte colony-stimulating factor plus anti-thymocyte globulin, which included individualized conditioning regimens, novel donor selection algorithm, and risk-directed strategies for GvHD and relapse, etc. Haplo-HSCT following “Beijing protocol” demonstrated similar efficacy to HLA-matched SCT, which has become the predominant strategy for allogeneic SCT in China as well as inspiration for refinement of global practice. This review will focus on recent progressions and prospective of this approach in (1) the indications from hematological malignancies to non-malignant diseases; (2) microenvironment for hematopoietic recovery; and (3) improving T cells function.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Al Malki MM, Jones R, Ma Q, Lee D, Reisner Y, et al. Proceedings from the fourth haploidentical stem cell transplantation symposium (HAPLO2016), San Diego, California, December 1, 2016. Biol Blood Marrow Transplant. 2018;24:895–908.

    Article  PubMed  Google Scholar 

  2. Kanakry CG, Fuchs EJ, Luznik L. Modern approaches to HLA-haploidentical blood or marrow transplantation. Nat Rev Clin Oncol. 2016;13:10–24.

    Article  CAS  PubMed  Google Scholar 

  3. Aversa F, Tabilio A, Terenzi A, Velardi A, Falzetti F, et al. Successful engraftment of T-cell-depleted haploidentical “three-loci” incompatible transplants in leukemia patients by addition of recombinant human granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells to bone marrow inoculum. Blood. 1994;84:3948–55.

    Article  CAS  PubMed  Google Scholar 

  4. Aversa F, Terenzi A, Tabilio A, Falzetti F, Carotti A, et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol. 2005;23:3447–54.

    Article  PubMed  Google Scholar 

  5. Huang XJ, Han W, Xu LP, Chen YH, Liu DH, et al. A novel approach to human leukocyte antigen-mismatched transplantation in patients with malignant hematological disease. Chin Med J (Engl). 2004;117:1778–85.

    Google Scholar 

  6. Huang XJ, Liu DH, Liu KY, Xu LP, Chen H, et al. Haploidentical hematopoietic stem cell transplantation without in vitro T-cell depletion for the treatment of hematological malignancies. Bone Marrow Transplant. 2006;38:291–7.

    Article  PubMed  Google Scholar 

  7. O’Donnell PV, Luznik L, Jones RJ, Vogelsang GB, Leffell MS, et al. Nonmyeloablative bone marrow transplantation from partially HLA-mismatched related donors using posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2002;8:377–86.

    Article  PubMed  Google Scholar 

  8. Luznik L, O’Donnell PV, Symons HJ, Chen AR, Leffell MS, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant. 2008;14:641–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Chang YJ, Huang XJ. Haploidentical SCT: the mechanisms underlying the crossing of HLA barriers. Bone Marrow Transplant. 2014;49:873–9.

    Article  CAS  PubMed  Google Scholar 

  10. Wang K, Lv M, Chang YJ, Zhao XY, Zhao XS, et al. Early myeloid-derived suppressor cells (HLA-DR(−)/(low)CD33( + )CD16(−)) expanded by granulocyte colony-stimulating factor prevent acute graft-versus-host disease (GVHD) in humanized mouse and might contribute to lower GVHD in patients post allo-HSCT. J Hematol Oncol. 2019;12:31.

    Article  CAS  PubMed  Google Scholar 

  11. Liu QF, Fan ZP, Wu MQ, Sun J, Wu XL, et al. Allo-HSCT for acute leukemia of ambiguous lineage in adults: the comparison between standard conditioning and intensified conditioning regimens. Ann Hematol. 2013;92:679–87.

    Article  CAS  PubMed  Google Scholar 

  12. Sun YQ, Xu LP, Zhang XH, Liu DH, Chen H, et al. A retrospective comparison of BU-fludarabine and BU-CY regimens in elderly patients or in patients with comorbidities who received unmanipulated haploidentical hematopoietic SCT. Bone Marrow Transplant. 2015;50:601–3.

    Article  CAS  PubMed  Google Scholar 

  13. Fu H, Xu L, Liu D, Liu K, Zhang X, et al. Total body irradiation and cyclophosphamide plus antithymocyte globulin regimen is well tolerated and promotes stable engraftment as a preparative regimen before T cell-replete haploidentical transplantation for acute leukemia. Biol Blood Marrow Transplant. 2014;20:1176–82.

    Article  CAS  PubMed  Google Scholar 

  14. Chang YJ, Zhao XY, Xu LP, Zhang XH, Wang Y, et al. Donor-specific anti-human leukocyte antigen antibodies were associated with primary graft failure after unmanipulated haploidentical blood and marrow transplantation: a prospective study with randomly assigned training and validation sets. J Hematol Oncol. 2015;8:84.

    Article  PubMed  CAS  Google Scholar 

  15. Wang Y, Chang YJ, Xu LP, Liu KY, Liu DH, et al. Who is the best donor for a related HLA haplotype-mismatched transplant? Blood. 2014;124:843–50.

    Article  CAS  PubMed  Google Scholar 

  16. Chang YJ, Xu LP, Wang Y, Zhang XH, Chen H, et al. Controlled, randomized, open-label trial of risk-stratified corticosteroid prevention of acute graft-versus-host disease after haploidentical transplantation. J Clin Oncol. 2016;34:1855–63.

    Article  CAS  PubMed  Google Scholar 

  17. Yan CH, Wang Y, Wang JZ, Chen YH, Chen Y, et al. Minimal residual disease- and graft-vs.-host disease-guided multiple consolidation chemotherapy and donor lymphocyte infusion prevent second acute leukemia relapse after allotransplant. J Hematol Oncol. 2016;9:87.

    Article  PubMed  Google Scholar 

  18. Apperley J, Niederwieser D, Huang XJ, Nagler A, Fuchs E, et al. Haploidentical hematopoietic stem cell transplantation: a global overview comparing Asia, the European Union, and the United States. Biol Blood Marrow Transplant. 2016;22:23–6.

    Article  PubMed  Google Scholar 

  19. Wang Y, Liu QF, Xu LP, Liu KY, Zhang XH, et al. Haploidentical vs identical-sibling transplant for AML in remission: a multicenter, prospective study. Blood 2015;125:3956–62.

    Article  CAS  PubMed  Google Scholar 

  20. Wang Y, Liu QF, Xu LP, Liu KY, Zhang XH, et al. Haploidentical versus matched-sibling transplant in adults with Philadelphia-negative high-risk acute lymphoblastic leukemia: a biologically phase III randomized study. Clin Cancer Res. 2016;22:3467–76.

    Article  CAS  PubMed  Google Scholar 

  21. Wang Y, Wang HX, Lai YR, Sun ZM, Wu DP, et al. Haploidentical transplant for myelodysplastic syndrome: registry-based comparison with identical sibling transplant. Leukemia 2016;30:2055–63.

    Article  CAS  PubMed  Google Scholar 

  22. Sun Y, Beohou E, Labopin M, Volin L, Milpied N, et al. Unmanipulated haploidentical versus matched unrelated donor allogeneic stem cell transplantation in adult patients with acute myelogenous leukemia in first remission: a retrospective pair-matched comparative study of the Beijing approach with the EBMT database. Haematologica 2016;101:e352–4.

    Article  PubMed  Google Scholar 

  23. Xu LP, Liu KY, Liu DH, Han W, Chen H, et al. A novel protocol for haploidentical hematopoietic SCT without in vitro T-cell depletion in the treatment of severe acquired aplastic anemia. Bone Marrow Transplant. 2012;47:1507–12.

    Article  CAS  PubMed  Google Scholar 

  24. Gao L, Li Y, Zhang Y, Chen X, Gao L, et al. Long-term outcome of HLA-haploidentical hematopoietic SCT without in vitro T-cell depletion for adult severe aplastic anemia after modified conditioning and supportive therapy. Bone Marrow Transplant. 2014;49:519–24.

    Article  CAS  PubMed  Google Scholar 

  25. Wu Y, Cao Y, Li X, Xu L, Wang Z, et al. Cotransplantation of haploidentical hematopoietic and umbilical cord mesenchymal stem cells for severe aplastic anemia: successful engraftment and mild GVHD. Stem Cell Res. 2014;12:132–8.

    Article  CAS  PubMed  Google Scholar 

  26. Wang Z, Zheng X, Yan H, Li D, Wang H. Good outcome of haploidentical hematopoietic SCT as a salvage therapy in children and adolescents with acquired severe aplastic anemia. Bone Marrow Transplant. 2014;49:1481–5.

    Article  CAS  PubMed  Google Scholar 

  27. Wang H, Wang Z, Zheng X, Ding L, Zhu L, et al. Hematopoietic stem cell transplantation with umbilical cord multipotent stromal cell infusion for the treatment of aplastic anemia–a single-center experience. Cytotherapy. 2013;15:1118–25.

    Article  CAS  PubMed  Google Scholar 

  28. Xu LP, Wang SQ, Wu DP, Wang JM, Gao SJ, et al. Haplo-identical transplantation for acquired severe aplastic anaemia in a multicentre prospective study. Br J Haematol. 2016;175:265–74.

    Article  PubMed  Google Scholar 

  29. Xu LP, Jin S, Wang SQ, Xia LH, Bai H, et al. Upfront haploidentical transplant for acquired severe aplastic anemia: registry-based comparison with matched related transplant. J Hematol Oncol. 2017;10:25.

    Article  PubMed  CAS  Google Scholar 

  30. Xu LP, Zhang XH, Wang FR, Mo XD, Han TT, et al. Haploidentical transplantation for pediatric patients with acquired severe aplastic anemia. Bone Marrow Transplant. 2017;52:381–7.

    Article  CAS  PubMed  Google Scholar 

  31. Wang WJ, Sun YQ, Tang FF, Han TT, Mo XD, et al. [Outcomes of alternative donor allogeneic hematopoietic stem cell transplantation for Fanconi anemia: a five cases report]. Zhonghua Nei Ke Za Zhi. 2018;57:54–6.

    CAS  PubMed  Google Scholar 

  32. Tian H, Liu L, Chen J, Xu Y, Jin Z, et al. Haploidentical hematopoietic stem cell transplant in paroxysmal nocturnal hemoglobinuria. Leuk Lymphoma. 2016;57:835–41.

    Article  CAS  PubMed  Google Scholar 

  33. Chen Y, Xu LP, Zhang XH, Chen H, Wang FR, et al. Busulfan, Fludarabine, and Cyclophosphamide (BFC) conditioning allowed stable engraftment after haplo-identical allogeneic stem cell transplantation in children with adrenoleukodystrophy and mucopolysaccharidosis. Bone Marrow Transplant. 2018;53:770–3.

    Article  CAS  PubMed  Google Scholar 

  34. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016;172:187–207.

    Article  PubMed  Google Scholar 

  35. Xu L, Chen H, Chen J, Han M, Huang H, et al. The consensus on indications, conditioning regimen, and donor selection of allogeneic hematopoietic cell transplantation for hematological diseases in China-recommendations from the Chinese Society of Hematology. J Hematol Oncol. 2018;11:33.

    Article  PubMed  Google Scholar 

  36. Kong Y, Chang YJ, Wang YZ, Chen YH, Han W, et al. Association of an impaired bone marrow microenvironment with secondary poor graft function after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19:1465–73.

    Article  PubMed  Google Scholar 

  37. Kong Y, Wang YT, Hu Y, Han W, Chang YJ, et al. The bone marrow microenvironment is similarly impaired in allogeneic hematopoietic stem cell transplantation patients with early and late poor graft function. Bone Marrow Transplant. 2016;51:249–55.

    Article  CAS  PubMed  Google Scholar 

  38. Shi MM, Kong Y, Song Y, Sun YQ, Wang Y, et al. Atorvastatin enhances endothelial cell function in posttransplant poor graft function. Blood 2016;128:2988–99.

    Article  CAS  PubMed  Google Scholar 

  39. Kong Y, Wang Y, Zhang YY, Shi MM, Mo XD, et al. Prophylactic oral NAC reduced poor hematopoietic reconstitution by improving endothelial cells after haploidentical transplantation. Blood Adv. 2019;3:1303–17.

    Article  CAS  PubMed  Google Scholar 

  40. Wang Y, Chang Y, Chen L, Xu L, Bian Z, et al. Low-dose post-transplant cyclophosphamide can mitigate GVHD and enhance the G-CSF/ATG induced GVHD protective activity and improve haploidentical transplant outcomes. Oncoimmunology 2017;6:e1356152.

    Article  PubMed  Google Scholar 

  41. Liu L, Chang YJ, Xu LP, Zhang XH, Wang Y, et al. T cell exhaustion characterized by compromised MHC class I and II restricted cytotoxic activity associates with acute B lymphoblastic leukemia relapse after allogeneic hematopoietic stem cell transplantation. Clin Immunol. 2018;190:32–40.

    Article  CAS  PubMed  Google Scholar 

  42. Liu L, Chang YJ, Xu LP, Zhang XH, Wang Y, et al. Reversal of T cell exhaustion by the first donor lymphocyte infusion is associated with the persistently effective antileukemic responses in patients with relapsed AML after Allo-HSCT. Biol Blood Marrow Transplant. 2018;24:1350–9.

    Article  CAS  PubMed  Google Scholar 

  43. Bian Z, Liu J, Xu LP, Chang YJ, Wang Y, et al. Association of Epstein-Barr virus reactivation with the recovery of CD4/CD8 double-negative T lymphocytes after haploidentical hematopoietic stem cell transplantation. Bone Marrow Transplant. 2017;52:264–9.

    Article  CAS  PubMed  Google Scholar 

  44. Bian Z, Xu LP, Fu Q, Huo M, Liu L, et al. Homeostatic gammadelta T cell contents are preserved by granulocyte colony-stimulating factor priming and correlate with the early recovery of gammadelta t cell subsets after haploidentical hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2018;24:252–9.

    Article  CAS  PubMed  Google Scholar 

  45. Wang X, Liu J, Gao H, Mo XD, Han T, et al. Dendritic cells are critical for the activation and expansion of Vdelta2(+) T cells after allogeneic hematopoietic transplantation. Front Immunol. 2018;9:2528.

    Article  PubMed  CAS  Google Scholar 

  46. Liu J, Chang YJ, Yan CH, Xu LP, Jiang ZF, et al. Poor CMV-specific CD8+ T central memory subset recovery at early stage post-HSCT associates with refractory and recurrent CMV reactivation. J Infect. 2016;73:261–70.

    Article  PubMed  Google Scholar 

  47. Zhao XY, Pei XY, Chang YJ, Yu XX, Xu LP, et al: First-line therapy with donor-derived HCMV-specific T cells reduces persistent HCMV infection by promoting antiviral immunity after allogenic stem cell transplantation. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz368.

  48. Lee KH, Lee JH, Lee JH, Kim DY, Seol M, et al. Reduced-intensity conditioning therapy with busulfan, fludarabine, and antithymocyte globulin for HLA-haploidentical hematopoietic cell transplantation in acute leukemia and myelodysplastic syndrome. Blood 2011;118:2609–17.

    Article  CAS  PubMed  Google Scholar 

  49. Di Bartolomeo P, Santarone S, De Angelis G, Picardi A, Cudillo L, et al. Haploidentical, unmanipulated, G-CSF-primed bone marrow transplantation for patients with high-risk hematologic malignancies. Blood 2013;121:849–57.

    Article  PubMed  CAS  Google Scholar 

  50. Chen Y, Cheng Y, Suo P, Yan C, Wang Y, et al. Donor-derived CD19-targeted T cell infusion induces minimal residual disease-negative remission in relapsed B-cell acute lymphoblastic leukaemia with no response to donor lymphocyte infusions after haploidentical haematopoietic stem cell transplantation. Br J Haematol. 2017;179:598–605.

    Article  CAS  PubMed  Google Scholar 

  51. Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu X, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood 2017;130:1156–64.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by National key research and development plan of China (2017YFA0104500). National Natural Science Foundation of China (Grant No.81873445). Publication of this supplement was sponsored by Gilead Sciences Europe Ltd, Cell Source, Inc., The Chorafas Institute for Scientific Exchange of the Weizmann Institute of Science, Kiadis Pharma, Miltenyi Biotec, Celgene, Centro Servizi Congressuali, Almog Diagnostic.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xiao-jun Huang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lv, M., Chang, Yj. & Huang, Xj. Update of the “Beijing Protocol” haplo-identical hematopoietic stem cell transplantation. Bone Marrow Transplant 54 (Suppl 2), 703–707 (2019). https://doi.org/10.1038/s41409-019-0605-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-019-0605-2

This article is cited by

Search

Quick links