EHA 2026 | Targeted therapies and immunotherapy are redefining transplantation in AML

Transplant is the best, or used to be the only, and the best immunotherapy that we have because of the attack of the donor immune cells against the patient’s tumor, so the so-called graft-versus-leukemia effect. And as for immunotherapy, we had the donor lymphocyte infusion that was the first type of immunotherapy, so alloactive cells. Yes, today immunotherapy is flourishing, and it’s really nice to see it, both the adoptive cellular therapy, the CAR T-cell, chimeric antigen receptors, and the immunotherapy. In ALL, myeloma, every disease we have, less so in myeloid malignancies like AML, myelodysplastic syndrome, and myeloproliferative disorders. I would say that transplant for myeloid malignancies is still the only way to cure these diseases. For lymphatic malignancies, this may be questionable, although in lymphoma there is almost no role for transplant in most of the lymphoma categories, let’s say, at least in B-cell lymphoma. T-cell lymphoma, I mean, is something else. And in myeloma, again, I mean, with the B-specific antibody, T-cell engager, CAR T-cells, the role of transplantation is becoming less. Although we still, you know, I mean, in myeloma, transplantation is still, you know, upfront transplant, the results are better, but there is more and more data. For instance, you don’t need to do a tandem transplant. And, you know, there are studies now that question the role of autologous transplantation. So, and also, you know, transplant is not by itself. So the targeted therapy, you can give pre-transplantation in order to get the patient to transplant in remission or with less tumor on board. And then in the transplant, you can give light conditioning and not heavy conditioning. So for ALL, if the patient is MRD pre-transplant positive, we will give inotuzumab to get it in MRD. And this is just an example. And then you can give this targeted therapy post-transplantation in order either prophylactic or preventive to prevent relapse. So I would say that the transplant is still, in many patients, a curative therapy. And the targeted therapy, you know, pre- and post-transplant will even improve the result of transplantation and I would say the transplant is here to stay at least for myeloid malignancies.

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