Irradiation-free, T-cell replete haploidentical transplant for Fanconi anaemia, weighing the benefits

The optimal haploidentical haematopoietic cell transplant approach for Fanconi anaemia (FA) patients is not well established, given the rarity of the disease, the increased sensitivity to DNA-damaging agents and the high risk of severe graft-versus-host disease (GVHD). The report by Xu et al. suggests that excellent engraftment and short-term survival can be achieved in FA patients without irradiation, but their retrospective cohort was plagued by a high rate of severe GVHD. Our commentary explores the outcomes in T-cell replete haploidentical haematopoietic cell transplant and ponders whether elimination of total body irradiation in FA patients is the best method if it limits the ability to safely administer post-transplant cyclophosphamide.

Automated summary

The optimal approach for haploidentical haematopoietic cell transplant in Fanconi anaemia patients is still uncertain due to the rarity of the disease, increased sensitivity to DNA-damaging agents, and high risk of severe graft-versus-host disease. This commentary explores the outcomes in T-cell replete haploidentical haematopoietic cell transplant and discusses the potential drawbacks of eliminating total body irradiation in these patients.