In this issue of the South Asian Journal of Cancer, Pallavi Mehta and Vishvdeep Khushoo have reported on their real-world experience with haploidentical (HI) hematopoietic cell transplantation (HCT) for hematological disorders.[1]

HCT commenced in India way back when a young girl with acute myeloid leukemia (AML) underwent allogeneic matched sibling HCT at Tata Memorial Hospital (TMH), Mumbai, Maharashtra, India.[2] Thereafter, TMH continued to be at the forefront by doing the first umbilical cord blood transplantation and even the first HIHCT.[3] Today, more than 100 centers offer HCT as standard therapy across India. It is estimated that so far, the Indian Society of Blood and Marrow Transplant has data of at least 3,200 HIHCT and 1,066 matched unrelated donor transplants (between 2012 and 2021). Estimate of annual national number of HCT done is 2,500 and HIHCT is 800 in various active centers from India. A quick PubMed search on HI, HCT, and India resulted in 147 hits, of which 8 articles were within the first 3 months of 2025.[4] Clearly, HIHCT have become standard of care, and thanks to the widespread availability of HIHCT, every eligible patient now has the ability to receive potentially curative allogeneic transplantation. That outcome with HIHCT is now similar to every other standard of care option—human leukocyte antigen (HLA)-matched sibling donor transplantation, HLA-identical unrelated donor transplantation, and umbilical cord blood transplantation. In a study consisting of 58 patients with acute lymphoblastic leukemia, total marrow and lymphoid irradiation and cyclophosphamide resulted in a good outcome, especially for those undergoing HIHCT.[5] Pallavi Mehta's data even showed that there was no statistical difference in progression-free survival (p = 0.796) and overall survival (OS) (p = 0.988) when comparing their patients with pretransplant complete remission 1 versus complete remission 2.[1] We are sure that they will continue to analyze their patients for a longer follow-up and can also do additional evaluation of posttransplant immune reconstitution—two sets of data points that would strengthen their results further.

In some cases, allogeneic HCT is the only potentially curative option. Take the example of dyskeratosis congenital, which often results in marrow failure and even AML. Even though HCT is the only curative option, it is associated with a high mortality. This is because their chromosomal instability leads to high sensitivity to radiation as well as alkylating agents.[6] Management includes treosulfan-reduced-intensity conditioning as well as modified PTCy-based prophylaxis against graft versus host disease (GVHD). A recent publication includes such a case with mutation in the DKC1 and RUNX1 genes. Interestingly, the maternal sides were careers and the paternal second-degree sibling was used as the HI donor.[6]

So, where do we go from here with HIHCT? Relapse still is the primary cause of death. And infection is primarily due to multidrug-resistant (MDR) bacteria or reactivation of cytomegalovirus (CMV)/Epstein-Barr virus. A report from Adyar included 21 patients undergoing HIHCT between 2014 and 2019. At that time 2-year OS was 38% and transplant-related mortality was also 38% (mainly due to MDR bacterial infection).[7]

Article published online:
23 December 2025

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