The faculty open by framing the current state of allogeneic stem cell transplantation, describing an era in which a suitable donor can be identified for the vast majority of patients and in which advances in upfront treatment of hematologic malignancies are bringing more patients into remission and therefore into transplant eligibility.

Caspian Oliai, MD, MS, interprets the phase 3 Precision-T trial, which compared Orca-T with a standard allogeneic transplant using tacrolimus and methotrexate under myeloablative conditioning, as an unequivocal advantage for Orca-T over a T-cell replete graft in that setting. The more interesting and still unanswered question, in his view, is how Orca-T would perform head to head against post-transplant cyclophosphamide, particularly with reduced-intensity conditioning.

Rawan Faramand, MD, describes how she selects a transplant approach in clinic. She starts with the disease and its risk of relapse and asks whether newer therapies can deepen remission before transplant.

Caspian Oliai, MD, MS, frames the choice among cell therapy products for acute leukemia around a single question: can the disease be cured by targeting one antigen, or does it require a more nonspecific but still robust immunotherapy.

Rawan Faramand, MD, addresses the uneven distribution of access to allogeneic transplant and to newer transplant technologies.

Caspian Oliai, MD, MS, reviews how graft-vs-host disease (GVHD) prophylaxis has evolved and where its toxicity is underappreciated.

Rawan Faramand, MD, says the finding that stands out most from newer approaches is the nonrelapse mortality of about 3% reported in the Precision-T trial, which compares favorably with historical rates of 15% to 20%, particularly in the myeloablative setting.

Robert Negrin, MD, asks whether lower nonrelapse mortality with the Orca-T approach could allow higher-intensity conditioning to be delivered safely to older patients.