Wednesday, February 26, 2014
Memorial Sloan Kettering’s achievements in blood and marrow stem cell transplantation are center stage at the 2014 BMT Tandem Meeting, a joint conference of the American Society of Blood and Marrow Transplantation and the Center for International Blood and Marrow Transplant Research, taking place in the Dallas area through March 2. To help us understand how the meeting is unfolding, we asked several of our doctors to provide us with daily highlights.
Monday was the first day of the Blood and Marrow Clinical Trials Network (BMT CTN) State of the Science Symposium, where the clinical research agenda for the network of participating centers was established for the next several years.
The BMT CTN, of which Memorial Sloan Kettering is a founding member, has been very successful since its inception in 2001. It has led 22 trials in stem cell transplantation that have resulted in 28 publications, several in high-impact journals, and some of which have led to changes in practice. One recent trial, for example, investigated the use of CD34-selected grafts to reduce graft-versus-host disease after allogeneic transplant, and was based on a strategy pioneered at Memorial Sloan Kettering by Richard O’Reilly [Chair of the Department of Pediatrics]. The use of CD34-selected grafts will now be tested in a multicenter phase III randomized study that I am co-leading.
The symposium consists of a series of reports by different disease-focused committees. One of the main themes from both the Leukemia and Lymphoma Committees was the concept of post-transplant maintenance to reduce relapse. Two proposals for randomized phase III studies in patients with leukemia addressed this: one looking at the use of FLT3 inhibitors in FLT3 AML patients and the other at low-dose azacytidine in patients with AML or MDS who have received an allogeneic transplant. In lymphoma, post-transplant maintenance with the targeted therapy ibrutinib was proposed in patients with poor-risk diffuse large B cell lymphoma after autologous transplant.
The Myeloma Committee, headed by [Adult Bone Marrow Transplant Chief] Sergio Giralt, agreed that the next trial to plan and perform should focus on defining whether risk-adapted therapy (prognostic index plus response) should be used to guide treatment.
For standard-risk myeloma patients, two potential studies include a randomized trial of high-dose therapy versus continued standard therapy for patients achieving an MRD-negative state, or a trial of continued maintenance therapy versus observation in patients with no minimal residual disease.
For myeloma patients with “poor-risk” profiles or early relapse post autograft, continued exploration of allogeneic stem cell transplant should be the priority.