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.

 In 1990, the Asia-Pacific Blood and Marrow Transplantation Group (APBMT) was founded, aiming to facilitate the activity of hematopoietic cell transplantation (HCT) in the region. Currently, a total of 22 countries/regions in the Asia-Pacific (AP) region participate in the activities of APBMT. The major activities of APBMT include (1) conducting an annual survey of HCT activities in each participating country/region, (2) operating the APBMT Registry, (3) training personnel and human resource development in developing countries/regions, (4) establishing transplant center standards in the AP region, and (5) providing information to the attending physicians of foreign patients staying in Japan who need HCT. Countries/regions in the AP region differ in population, land area, language, and economic status. In light of this diversity, this paper will outline the activities undertaken and the challenges that lie ahead for the promotion and development of HCT in this region.

 Patients undergoing hematopoietic stem cell transplant (HSCT) often experience a decline in physical function related factors such as muscle strength and endurance, mental issues such as anxiety and depression, fatigue, and psychological effects due to post-transplant complications and inactivity associated with HSCT. This leads to a decrease in their ability to perform daily activities and quality of life (QOL). Exercise therapy during HSCT can help maintain physical function and QOL and reduce fatigue. Therefore, a program combining aerobic and strength training exercises should be included for these patients. However, exercise intensity and the program must be carefully considered for patients with anemia and low platelet counts, which may occur during the myelosuppression phase. This review highlights the benefits of exercise therapy for HSCT patients (primarily, allogeneic HSCT patients) and provides guidelines for risk management during exercise therapy interventions.

 CD19-redirected chimeric antigen receptor (CAR) T cell therapy has achieved remarkable success in hematological malignancies. However, targeting solid tumor is still challenging. T cell exhaustion is one of the major barriers in tumor microenvironment of solid tumors. In this review, we summarize the multifaceted mechanisms of T cell exhaustion and describe a new insight of CAR T cell exhaustion characterized by a T to NK like transition. Furthermore, the strategies to overcome T cell exhaustion to improve the efficacy of CAR T cell therapy will be addressed.

 A 29-year-old man in his second remission of acute myeloid leukemia underwent cord blood transplantation. During the course of the disease, pre-engraftment immune reaction occurred, which improved with steroid therapy; however, he developed human herpesvirus-6B (HHV-6B) encephalitis. Antiviral drugs were administered, which improved his condition; however, plasma HHV-6B DNA levels continued to increase even after treatment. Although his neurological symptoms did not worsen, antiviral drug treatment was continued because he had severe immunodeficiency. He developed acute heart failure 139 days after transplantation and eventually died, but autopsy showed no evidence of encephalitis. Patients who do not test negative for HHV-6B DNA should undergo individualized treatments based on their clinical status; however, antiviral drug therapy should have been discontinued in the present case. In cases where the polymerase chain reaction (PCR) results remain positive, plasma PCR is not a useful method to help determine the treatment duration, and the efficacy of antiviral drugs is also unknown. Hence, further studies should be conducted to understand situations like this case.