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Transplant Remains Pivotal in Myeloma, Other Hematologic Cancers

Gina Columbus @ginacolumbusonc
Published: Monday, Jan 02, 2017

Sergio Giralt, MD

Sergio Giralt, MD

The use of stem cell transplantation has changed over the last few years, with the emergence of novel therapies and treatment strategies. But even with the FDA approvals of new agents for multiple myeloma and select lymphomas, transplant remains to be a curative and reliable strategy.

In an interview during the meeting, Giralt, a professor of Medicine at Memorial Sloan Kettering Cancer Center, discussed the advances in stem cell transplant and how it remains as the sole curative therapy in various hematologic malignancies.

OncLive: Please provide an overview of your lecture at this State of the Science Summit.

Giralt: I summarized what I thought were the best abstracts from the 2016 ASH Annual Meeting in San Diego in the area of stem cell transplant and cellular therapies. There were some that were really practice changing and probably the start of new eras. Sattva S. Neelapu, MD, presented the first 51 patients with relapsed/refractory DLBCL treated with a CD19 chimeric antigen receptor (CAR)-modified T-cell therapy. These were dramatic responses; people who had extensive disease achieved complete remissions.

Why is there the difference between the American trial and the European trial? In the American trial, 32% of patients randomized to tandem did not get the tandem arm. Could that explain the difference? We don’t know; we need further follow-up. This question has not yet been totally answered, in that risk-adapted or response-adapted therapy with minimal residual disease (MRD) assessment will be the way we will tailor treatment for patients with myeloma to give them the longest life and best quality of life with a minimum burden of treatment.

What will the role of transplant be in the future?

That is an excellent question. Transplant remains the only curative strategy for many patients with hematologic malignancies. It is the only curative strategy in myelodysplastic syndromes (MDS), in acute leukemia for patients who failed primary therapy, and in high-risk leukemia.
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