Post-transplant maintenance therapy: emerging concepts and future perspectives

Abstract

 Allogeneic hematopoietic stem cell transplantation (HSCT) has aimed to eradicate residual hematological tumors by myeloablative cytotoxic conditioning and following immunological GVT effect. However, post-transplant relapse still remains one of the most important challenges in HSCT. In the past decade, progress in genomics has led to the steady development of various antitumor agents. Based on the situations, novel strategies are being explored that incorporate newly-developed agents in the peri-transplant period, which intend to minimize the amount of residual tumor before transplant (bridging to transplant) and suppress disease recurrence after transplant (post-transplant maintenance therapy). In particular, the safety and efficacy of post-transplant maintenance therapy for patients with therapeutic molecular targets has been well recognized, and changing the overall schema of HSCT. Future implementation of comprehensive genetic screening and highly-sensitive MRD measurement will enable to conduct necessary and sufficient post-transplant therapy. The establishment of a clinical approach based on objective information will greatly accelerate the trend toward personalized medicine in post-transplant therapy and realize safer and more effective management for patients after HSCT.