Transplant Is a Mainstay in Hematologic Cancers, Expert Says

Stem cell transplant is still the only curative treatment option for many hematologic malignancies, even as novel drugs continue to emerge. 
BY GINA COLUMBUS @ginacolumbusonc
Even as the US Food and Drug Administration (FDA) approved new agents for multiple myeloma and some lymphomas, stem cell transplant remains the only curative and reliable strategy for these patients.

Signs of this were especially seen in results of the phase 3 StaMINA trial in multiple myeloma, which found that the addition of Revlimid (lenalidomide)/Velcade (bortezomib)/dexamethasone consolidation or a second autologous hematopoietic cell transplant (AHCT) was not superior to a single AHCT, followed by Revlimid maintenance.

Sergio Giralt, M.D., discussed the evolution of stem cell transplant and cellular therapies.

He advises that, “Timely referral to transplant is probably the single most important thing. High-dose therapy and autologous transplant for multiple myeloma remains the standard of care.”

In an interview, Giralt, a professor of Medicine at Memorial Sloan Kettering Cancer Center, discussed the advances in stem cell transplant and how it remains as the sole curative therapy in various hematologic malignancies.

Can you provide an overview on your recent lecture on treatment for hematologic malignancies?

I summarized what I thought were the best abstracts from the 2016 ASH Annual Meeting in San Diego in the area of stem cell transplant and cellular therapies. There were some that were really practice changing and probably the start of new eras. Sattva S. Neelapu, M.D., presented the first 51 patients with relapsed/refractory DLBCL treated with a CD19 chimeric antigen receptor (CAR)-modified T-cell therapy. These were dramatic responses; people who had extensive disease achieved complete remissions.

It is still early—most of the patients were not even three to four months out of treatment. The treatment is associated with some toxicities and it probably has to be given in specialized centers. But these are people who had no viable therapeutic option. This is, really, a life-saving treatment.

There were two abstracts in myeloma that called to everybody’s attention. These were long awaited studies. One was presented by the Edward Stadtmauer, M.D. He presented the StaMINA trial, in which 700 patients were randomized to three types of posttransplant consolidation: standard Revlimid maintenance; four cycles of consolidation therapy with Velcade, Revlimid and dexamethasone; and a tandem transplant.

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