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COSTEM 2021 | The role of mutation screening in alloHSCT decision-making

Ibrahim Yakoub-Agha, MD, PhD, University of Lille, Lille, France, comments on the impacts of mutation screening on decision-making for allogeneic hematopoietic stem cell transplantation (alloHSCT) for patients with myelodysplastic syndromes (MDS). Prof. Yakoub-Agha describes how mutation screening can help to select patients who would benefit from alloHSCT, in particular in patients with an intermediate-risk International Prognostic Scoring System (IPSS) score. Mutational screening is not currently used to determine treatment strategies post-alloHSCT, although Prof. Yakoub-Agha reports that it could help in the identification of druggable targets. This interview took place at the 6th Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM), which took place virtually.

Transcript (edited for clarity)

We have this debate on the impact of gene mutations, and the management of patient of higher-risk MDS, especially with regard to allogeneic hematopoietic cell transplantation. Actually, we had very good argument, I would say, to implement the discussion. To summarize, I would say, gene mutation, we can gene use mutations at diagnosis actually to help us deciding for the indication of allogeneic hematopoietic stem cell transplantation for especially in patient with intermediate R-IPSS...

We have this debate on the impact of gene mutations, and the management of patient of higher-risk MDS, especially with regard to allogeneic hematopoietic cell transplantation. Actually, we had very good argument, I would say, to implement the discussion. To summarize, I would say, gene mutation, we can gene use mutations at diagnosis actually to help us deciding for the indication of allogeneic hematopoietic stem cell transplantation for especially in patient with intermediate R-IPSS. Because those patients, the decision it’s a bit difficult. The median survival is something like three years. It’s short for not proposing something more curative, I would say. And it’s long to avoid some toxicity of the procedure, et cetera. So, we can really relay the existence or not of gene mutation, the number of gene mutation, or the kind of gene mutation in those patients, and we can be more comfortable deciding for allogeneic transplantations.

So, can we use gene mutation or NGS, for instance, post-transplant to drive the decision how to deal with those patients after transplantation? Actually, this is not routinely used for now, and we don’t know exactly if we can use gene mutation as [inaudible] for MDS patients, you know, post-transplantation. But we can imagine we can use them in subset of patient to use the new drugs, you know, targeting this mutation for instance, or maybe to adapt immunosuppressive treatment. But it’s a bit early to put the gene mutation landscape in the management of patients after allogeneic transplantation.

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