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Relapse after HSCT 2021 | Strategies to prevent relapse after stem cell transplantation

Bart Scott, MD, Fred Hutchinson Cancer Research Center, Seattle, WA, talks on the strategies used to minimize the risk of relapse in patients with hematological malignancies undergoing stem cell transplantation. Whilst increasing the intensity of conditioning regimens has proven to reduce relapse risk, it is also associated with an increased toxicity. Dr Scott outlines several ongoing clinical trials exploring novel conditioning regimens which are less toxic. This interview took place at the 2021 Relapse After HSCT² Workshop in New York, NY.

Transcript (edited for clarity)

One of the biggest issues that we face for patients who undergo stem cell transplant is relapse of their primary disease. In fact, when you look overall at transplant outcomes, relapse remains the most common reason for failure, and this is regardless of type of donor that’s used.

There have been three large randomized trials evaluating conditioning intensity for patients who have myeloid malignancies...

One of the biggest issues that we face for patients who undergo stem cell transplant is relapse of their primary disease. In fact, when you look overall at transplant outcomes, relapse remains the most common reason for failure, and this is regardless of type of donor that’s used.

There have been three large randomized trials evaluating conditioning intensity for patients who have myeloid malignancies. At least one of them has shown that increasing conditioning intensity is an important component in reducing the risk of relapse in patients with myeloid malignancies. And this is particularly true if patients have minimal residual disease before transplant, but unfortunately, historically, increasing conditioning intensity has also gone along with increasing toxicity. So, essentially, what we want to do is try to disassociate conditioning intensity with conditioning toxicity through the exploration of novel mechanisms of conditioning regimens. That’s really what my talk focuses on, is novel conditioning regimens that have good intensity of conditioning, but without necessarily toxicity.

So, I go through several different clinical trials that we currently have open at the Fred Hutch, evaluating novel conditioning regimens such as those incorporating clofarabine, those incorporating treosulfan, those that are incorporating radiolabeled conditioning regimens with astatine, and those that are using antibody-based regimens, such as a new clinical trial that we have through JASPER, as ways to offer conditioning intensity, but not necessarily with increasing conditioning toxicity.

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