Introduction: Balancing GVHD Prevention and Immune Reconstitution
The landscape of allogeneic hematopoietic cell transplantation (HCT) has been defined by a precarious balance between preventing graft-versus-host disease (GVHD) and ensuring rapid immune recovery. Ex vivo CD34+ selection, a process that physically removes T-cells from the donor graft, has emerged as a powerful technique to minimize the risk of chronic GVHD without the need for prolonged immunosuppression. However, this method has historically been hampered by delayed immune reconstitution (IR), specifically the slow recovery of CD4+ T-cells, which increases the patient’s vulnerability to opportunistic infections and non-relapse mortality (NRM).
