Role of Transplant Across Hematologic Malignancies

Robert J. Soiffer, MD, the chair, Executive Committee for Clinical Programs, vice chair, Department of Medical Oncology, chief, Division of Hematologic Malignancies and institute physician at Dana-Farber Cancer Institute, as well as the Worthington and Margaret Collette Professor of Medicine in the Field of Hematologic Oncology, Harvard Medical School, discusses the use of transplant in various hematologic malignancies.

Transplant is a modality that has been used for more than 40 years for many patients with hematologic malignancies. However, research is currently evaluating chimeric antigen receptor T-cell therapy as a possible replacement and new standard of care.

Here, Soiffer discusses the role of transplantation for patients with non-Hodgkin lymphoma, the use of autologous transplant for patients with multiple myeloma, and allogeneic transplant for patients with acute leukemia or myelodysplastic syndrome (MDS).

Transcription:

0:08 | I’ll put it in the context of different settings. Let’s talk about a non-Hodgkin lymphoma. It is now considered, or it has been considered standard of care for patients with non-Hodgkin lymphoma who’ve relapsed after their initial therapy, particularly patients with large-cell lymphoma, to once they achieve a second remission move into an autologous transplant. That's been able to result in cures anywhere between 40% and 60% of patients who are able to successfully undergo a transplant, and that's in the lymphoma setting.

0:47 | In the world of multiple myeloma, autologous transplant again, using your own stem cells, is often used upfront. It may or may not really be a curative therapy, but it's certainly something that extends progression-free survival and allows patients to live for a long period of time without intervention.

1:07 | On the acute leukemia side, and let's say marrow disorders like MDS, allogeneic transplant can be curative for a variety of these disorders. The likelihood of cure depends a lot on the molecular and genetic composition of leukemia itself. So, individuals with very high-risk leukemias will do poorly with standard therapy. They'll do somewhat better with allogeneic transplant. In patients with let's say intermediate-risk leukemias who do modestly well with chemotherapy alone, do even better with an allogeneic transplant.