Timing of Referral for Transplant

Corey S. Cutler, MD, MPH, FRCPC: Today we are discussing the updates in the management of graft-vs-host disease. I’m Dr Corey Cutler from the Dana-Farber Cancer Institute and Harvard Medical School. Joining me today are my colleagues Dr Joseph Antin, also from the Dana-Farber Cancer Institute; and Drs Yi-Bin Chen and Zach DeFililpp, both of whom are from Massachusetts General Hospital. We’re going to discuss a number of topics pertaining to the management of graft-vs-host disease, including practical information for community oncologists. Our first topic is referrals for transplantation.

Dr Antin, can you review the main indications for transplant at our center? Then we’ll discuss the same question at Massachusetts General Hospital.

Joseph H. Antin, MD: Allogeneic transplants are principally applied in patients with acute myeloid leukemia and myelodysplastic syndrome. There are at least a dozen other diseases that are incurable with conventional therapy that transplant is amenable to, although those would be the No. 1 diagnoses.

Corey S. Cutler, MD, MPH, FRCPC: Dr Chen, do you want to elaborate on the rare diseases we see and the reasons a community oncologist might want to refer to a transplantation center?

Yi-Bin Chen, MD: Our center sees the same subset of diseases that you see at Dana-Farber. The majority of our volume is made up of patients with AML [acute myeloid leukemia] and MDS [myelodysplastic syndrome]. We see similar diseases that you see, including acute lymphoblastic leukemia. With certain rare types of lymphomas, we still move to allogeneic transplant. There’s benign hematological nonmalignant diseases, such as aplastic anemia, that are treated with allogeneic transplant. Years ago there were diseases that took to allogeneic transplant, but because of the development of other therapies, we don’t generally see them anymore for allogeneic transplant. These include patients with CML, or chronic myeloid leukemia, except in a small subset of patients; many patients with non-Hodgkin lymphoma; and multiple myeloma. These patients we rarely take to transplant at this point in time.

Transcript Edited for Clarity