Redefining Allogeneic Transplants & Cellular Therapy: Key Takeaways from EBMT 2025 - Episode 4
Balancing Cure and Toxicity: Tailoring AlloHSCT Intensity and Timing
Panelists discuss how selecting a conditioning regimen for allogeneic hematopoietic stem cell transplantation (alloHSCT) involves balancing curative potential with toxicity based on patient fitness and disease risk, while emphasizing the importance of early referral and multidisciplinary coordination to optimize timing and individualize treatment planning.
Summary for Physicians:
When considering alloHSCT, the choice of conditioning regimen—myeloablative conditioning (MAC), reduced-intensity conditioning (RIC), or nonmyeloablative conditioning (NMA)—is guided by balancing curative potential with treatment-related toxicity. Factors influencing this decision include the following:
- Patient-specific characteristics, such as age, comorbidities, organ function, and performance status.
- Disease status and risk of relapse, whereas MAC may be preferred for younger, fit patients with high-risk disease, RIC or NMA may be used in older or more frail patients to reduce toxicity while maintaining efficacy.
- Long-term outcomes and quality of life considerations, including risk of graft-versus-host diseaseand nonrelapse mortality.
In terms of referral practices, early and proactive collaboration between transplant teams and hematology/leukemia services is essential. Multidisciplinary coordination ensures the following:
- Patients are referred in a timely manner, ideally early in the disease course or once high-risk features are identified.
- Transplant evaluations can occur during remission or prior to disease progression.
- Shared decision-making supports optimal timing and treatment planning tailored to individual risk profiles and goals of care.
Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.
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