ASH News Daily 2017 - Issue 4 - A-5

Tuesday, December 12, 2017

ASH News Daily

Page A-5
®

T R A N S P L A N TAT I O N

Allogeneic Transplantation: Better, Safer, Stronger, and
Smarter in 2017
By Mehdi haMadani, Md

or 30 years and counting, the
number of allogeneic transplantations (alloHCT) performed in the United States has
continued to rise each year, with at
least 8,200 patients expected to undergo this potentially curative procedure in 2017, according to Center
for International Blood and Marrow Transplant Research (CIBMTR)
estimates. This remarkable rise is
sustained by ever-increasing donor
options, application of this modality
in older individuals, and reduced
transplant-related morbidity and
mortality in general.
Disease relapse remains the number one cause of therapy failure and
mortality after alloHCT; yet, research to prevent post-allograft disease relapse has not received the attention it warrants. Fortunately, this
is rapidly changing. At this year's
meeting, an education session titled
"When Graft Versus Tumor Fails:
The Biology and Treatment of Relapse After Allogeneic Stem Cell
Transplantation" was entirely devoted to this very important topic.
Dr. Frederik Falkenburg provided
an overview of the current understanding of so-called immune-mediated graft-versus-tumor effects.
He discussed the latest developments related to the understand-

ing of the biology of disease relapse
after alloHCT. Dr. Robert Soiffer
described the rationale for posttransplant relapse prevention with
pharmacologic agents. The malignant hematologic disorders and
maintenance agents currently available or in development covered in
his elegant talk included chronic
myeloid leukemia treated with
tyrosine kinase inhibitors, acute
myeloid leukemia (AML) targeted
with hypomethylating agents and
FLT3 inhibitors, myeloma treated
with proteasome inhibitors, IMIDs,
and monoclonal antibodies, and
lymphomas with monoclonal antibodies and targeted agents. He also
pointed out that an important international registration trial led by
BMT CTN was recently launched
to evaluate post-alloHCT maintenance with gilteritinib in FLT3-ITD
positive AML in first complete remission (NCT02997202).
Oral abstract #275 evaluated
checkpoint inhibitor use post-alloHCT and reported important efficacy and toxicity signals. Dr. Alan
Wayne focused on the use of cellular
therapies to prevent or treat disease
relapse after alloHCT. He said that,
"malignant cells can recruit immunosuppressive cells and produce inhibitory factors that create a tumor
microenvironment in which cancers
are able to avoid immune-mediated

killing. This tumor-permissive environment dampens effective immune
responses and blocks the function of
normal immune effector cells." Dr.
Wayne went on to discuss currently
available cell therapies to prevent
post-alloHCT relapse including natural killer cells, monocyte-derived
dendritic cell vaccines, donor lymphocyte infusion, antigen primed
cytotoxic T lymphocytes, cytokineinduced killer cells, marrow-infiltrating lymphocytes, and chimeric
antigen receptor T cells.
Important graft-versus-host disease (GVHD) -related abstracts reported utility of amphiregulin as a
novel biomarker to improve GVHD
risk-stratification (abstract #72),
abatacept for acute GVHD prevention (abstract #212), IL-2 augmented regulatory T-cell infusions for
steroid-refractory chronic GVHD
(abstract #511), and ixazomib for
preventing chronic GVHD (abstract
#1974). Dr. Kim and colleagues
(abstract #271) demonstrated for
the first time that post-transplant
next-generation sequencing (NGS)
-based monitoring in acute leukemia patients undergoing alloHCT
could predict risk of relapse. The
feasibility of using haploidentical
donors for alloHCT is now well
established, which means that clinicians often face the challenge of
picking the best donor for allograft-

ing (e.g., a younger haploidentical
donor vs. an older HLA-matched
sibling donor), with little data available to guide decision-making. The
answer to this question now comes
from a key CIBMTR/EBMT abstract (#851), reporting that for leukemia patients aged 55 to 76 years
compared to offspring donors, alloHCT from HLA-matched siblings
provides lower transplant-related
mortality and improved overall survival. The quest for a better lowerintensity regimen for alloHCT also
got a huge boost during this meeting, with a European study reporting superiority of treosulfan-based
reduced-intensity
conditioning
over traditional fludarabine-busulfan conditioning in a randomized
phase III trial, at least in leukemia/
MDS patients (abstract #521).
These data and CIBMTR trends
show that alloHCT is thriving in
the U.S., and the mindboggling variety of novel drugs are now finding
their role around a solid alloHCT
backbone to improve conditioning
regimens, reduce HCT complications, and mitigate risk of relapse.
In the year 2017, alloHCT is evolving to become a better, safer, stronger, and smarter tool in our fight to
end cancer.
Dr. Hamadani has received research
funding from Takeda Pharmaceuticals.

Fun & Games
at ASH 2017!

Pictured, L to R: Dr. Tala Achkar, Dr. Apurva Pandey,
and Dr. Christine Garcia are the Super Heroes of Hematology in the Selfie Zone.

Dr. James Gerson tests his cornhole
skills at ASH Central.

Attendees gather around an Alexa station to ask
questions in ASH Central.

Anna Lindh and Dr. Johanna Repits are all smiles at
the Super Heroes of Hematology photo booth.

Dr. Rushing Patel makes an origami crane for the 1,000
Cranes of Hope project as Adrienne Ballenger looks on.

Table of Contents for the Digital Edition of ASH News Daily 2017 - Issue 4

ASH News Daily 2017 - Issue 4 - A-1
ASH News Daily 2017 - Issue 4 - A-2
ASH News Daily 2017 - Issue 4 - A-3
ASH News Daily 2017 - Issue 4 - A-4
ASH News Daily 2017 - Issue 4 - A-5
ASH News Daily 2017 - Issue 4 - A-6
ASH News Daily 2017 - Issue 4 - A-7
ASH News Daily 2017 - Issue 4 - A-8
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