Clinical Outcomes of Stem Cell Transplants in Cancer Treatment

Dear Colleagues,

Hematopoietic stem cell transplantation (HSCT) has become a well-established treatment for various malignant and non-malignant disorders originating from the hematopoietic system. Improvements in transplantation techniques in recent years have led to a significant reduction in treatment-related complications. Importantly, this decline in mortality occurred despite the fact that older patients and patients with more comorbidities have been undergoing allogeneic HSCT in increasing numbers in recent decades. Areas of improvement have included changes in conditioning regimens, larger donor availability, better HLA-matching techniques and graft source manipulation, advanced techniques to detect minimal residual disease, post-transplant immunotherapy, progress in supportive care, graft-versus-host disease (GVHD) prophylaxis and therapy, and detection and treatment of subsequent infections. Successful allogeneic HSCT requires the development of an immune tolerance toward both the donor and host allogeneic antigens. Induction of an immune tolerance can prevent T-cell-mediated graft rejection and GVHD, which cause a severe pathology in HSCT recipients. Moreover, in hematologic malignancies, maintaining effective anti-tumor control while inducing a sustained immune tolerance is critical to survival following allogeneic HSCT.

GVHD remains one of the main complications after allogeneic HSCT. Despite very intensive research, no major advances in the management of GVHD have been made during the last two decades, except for post-transplant cyclophosphamide. An increased frequency of post-transplant cyclophosphamide for GVHD prophylaxis has allowed haploidentical HSCT to become a widely used approach because of its simplicity, low transplant-related mortality, and low incidence of severe GVHD, markedly expanding the pool of available donors.

Many challenges remain, particularly in minimizing primary disease relapse, which remains the major cause of HSCT failure. The implementation of immune-based therapies with use of chimeric antigen receptor (CAR) T-cells, bispecific antibodies, and checkpoint inhibitors could help to prevent treatment relapse after HSCT.

Dr. Natalia Maximova
Guest Editor

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