ESH MDS 2024 | Optimizing donor selection & conditioning regimens for patients with MDS receiving alloSCT
Didier Blaise, MD, PhD, Institut Paoli-Calmettes, Marseille, France, shares insights into how to select the best donor and conditioning regimen when transplanting patients with myelodysplastic syndromes (MDS). Dr Blaise highlights that donor selection and availability are no longer a constraint for allogeneic stem cell transplantation (allo-SCT). However, the optimal conditioning regimen has not yet been identified. Dr Blaise suggests choosing the regimen with the lowest toxicity and, if necessary, combining this with additional treatment post-transplantation, such as maintenance therapy or immune stimulation. This interview took place at the European School of Hematology 9th Translational Research Conference on Myelodysplastic Syndromes (ESH MDS) in Budapest, Hungary.
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Transcript (edited for clarity)
In this situation, in fact, as I said previously, the donor is no longer an issue. The importance is to have a donor at the time that we need to do the transplantation. So, it could be an HLA-matched donor, that’s an ideal situation, but in older patients it is less than 20% of the cases, or an HLA-match unrelated donor or haplo donor. The results are identical and we have conducted several trials showing that...
In this situation, in fact, as I said previously, the donor is no longer an issue. The importance is to have a donor at the time that we need to do the transplantation. So, it could be an HLA-matched donor, that’s an ideal situation, but in older patients it is less than 20% of the cases, or an HLA-match unrelated donor or haplo donor. The results are identical and we have conducted several trials showing that.
In terms of conditioning regimen, it’s very tricky because, in fact, for years, we thought that the conditioning regimen will solve everything: the treatment of the disease, the engraftment of the graft, and the prophylaxis of relapse. It is not anymore the case. So, my recommendation concerning the conditioning regimen, I do not have a magical conditioning regimen, is to find the one with the lowest toxicity because in addition to what we can do at the real-time of transplantation, we can add other treatments after transplantation -maintenance therapy or immune stimulation after transplantation that could be of real importance. And in fact, the reality of transplantation at the present time is not anymore a very intense, in a short time treatment, but a prolonged treatment over several months, and it is really well-adapted to the frail patient and notably, the old patient.
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