What is the role of buffy coat in haploidentical (haplo) bone marrow transplantation?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: March 14, 2025 • View editorial policy

From the Guidelines

Buffy coat plays a significant role in haploidentical bone marrow transplantation as it provides a concentrated source of stem cells, allowing for a potentially life-saving alternative for patients with hematologic malignancies or bone marrow failure syndromes who lack a fully matched donor.

Key Points

  • The buffy coat layer of blood contains concentrated white blood cells, including stem cells, which can be used for haploidentical hematopoietic stem cell transplantation 1.
  • Post-transplant cyclophosphamide is commonly used as graft-versus-host disease (GVHD) prophylaxis in haploidentical transplants, typically administered at 50 mg/kg on days +3 and +4 after transplant.
  • The conditioning regimen for haploidentical transplants often includes fludarabine, cyclophosphamide, and total body irradiation, along with tacrolimus and mycophenolate mofetil for additional GVHD prevention.
  • The use of buffy coat cells in haploidentical transplants offers a valuable alternative for patients who lack a fully matched donor, with comparable outcomes to matched unrelated donor transplants in many settings.

Considerations

  • The haploidentical approach has gained popularity due to improved GVHD prevention strategies, making it a viable option for patients with hematologic malignancies or bone marrow failure syndromes.
  • The buffy coat approach provides a concentrated source of stem cells without requiring extensive processing facilities needed for CD34+ selection, making it a more accessible option for some patients.
  • However, the evidence for the use of buffy coat in haploidentical bone marrow transplantation is limited, and further studies are needed to fully understand its role and potential benefits 1.

From the Research

Role of Buffy Coat in Haploidentical Bone Marrow Transplantation

  • The buffy coat is a component of the blood that contains most of the white blood cells and platelets, and it has been used in the context of haploidentical bone marrow transplantation to treat various diseases, including myelodysplastic syndrome 2.
  • In one study, a patient with myelodysplastic syndrome who relapsed after allogeneic bone marrow transplantation was treated with infusions of donor buffy coat leukocytes, resulting in hematologic and cytogenetic remission, although severe graft-versus-host disease (GVHD) developed 2.
  • However, the use of buffy coat in haploidentical bone marrow transplantation is not a standard practice, and most studies have focused on the use of bone marrow or peripheral blood stem cells as the graft source 3, 4, 5, 6.
  • The role of buffy coat in haploidentical bone marrow transplantation is not well established, and further research is needed to determine its efficacy and safety in this context.

Haploidentical Bone Marrow Transplantation Outcomes

  • Haploidentical bone marrow transplantation has been shown to be a effective treatment option for patients with severe aplastic anemia, with a 1-year overall survival rate of 81% 3.
  • The use of reduced-intensity conditioning regimens, such as fludarabine and busulfan, has been associated with improved outcomes in haploidentical bone marrow transplantation 4.
  • Post-transplant cyclophosphamide has been used as a graft-versus-host disease (GVHD) prophylaxis in haploidentical bone marrow transplantation, and has been shown to be effective in reducing the incidence of GVHD 5, 6.
  • Haploidentical bone marrow transplantation has also been used to treat other diseases, including Fanconi anemia and sickle cell disease, with promising results 5, 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.