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The possibility to use a family donor sharing only one haplotype with recipient affected by hematological malignancy has been searched from many years because it allows having a donor in every case for every patient. At the beginning, this kind of transplantation was considered too toxic, but after the development of specific strategies of conditioning regimens and ex vivo T-cell depletion, its feasibility and efficacy has been proved, mainly for acute leukemia. However, these haploidentical programs with ex vivo T-cell depletion need of sophisticated and dedicated laboratories and are characterized by frequent infectious complications and relapse, because of delayed immune reconstitution. For these reasons, many groups have developed alternative program for haploidentical transplantation, without ex vivo T-cell depletion, obtaining encouraging results in haematological malignancies. In this review, we analyze data produced by different groups, underscoring their principal characteristics.

Most of patients with hematological malignancies are elderly (more than 60  years). Allogeneic stem cell transplantation is an important and effective treatment for most of these diseases. However, the toxicity and the supposed frailty of elderly patients, have limited the applicability of allogeneic transplantation for these patients. Elderly patients are at high risk to develop life-threatening complications, if allogeneic transplantation is performed with myeloablative conditioning regimens and using bone marrow stem source. Since more than 10 years, reduced intensity conditioning regimen have been developed, allowing to overcome the age as contra-indication for allogeneic transplantation. On the other hand, it is the presence of comorbidities which identify frail patients. For these subjects, allogeneic transplantation should be not indicated. Furthermore, advances in the supportive care and the development of new molecules could allow to reduce the toxicity of myeloablative conditioning regimens and thus to offer more intensive regimens before transplantation also in elderly population.