Strategies for preventing relapse after hematopoietic-cell transplantation (HCT).
| Allogeneic HCT . | Autologous HCT . |
|---|---|
| Abbreviations: HLA indicates human leukocyte antigen; KIR, killer immunoglobulin-like receptor; GVHD, graft-versus-host disease; DLI, donor leukocyte infusions; CML, chronic myeloid leukemia; IMiD, immunomodulatory drug | |
| Pre-transplantation | |
| Therapy to achieve maximal remission pre-HCT | Therapy to achieve maximal remission pre-HCT |
| Consider HCT early in disease course for high risk diseases (e.g., poor cytogenetics, presence of minimal residual disease) | Consider HCT early in disease course for high risk diseases (e.g., early relapse, presence of minimal residual disease) |
| At transplantation | |
| Use novel therapies to maximize eradication of minimal residual disease (e.g., radioimmunotherapy, monoclonal antibodies) | Use novel therapies to maximize eradication of minimal residual disease (e.g., radioimmunotherapy, monoclonal antibodies) |
| Graft selection (e.g., HLA or KIR mismatched donors) | Graft selection (e.g., maximize CD34+ cell collection) |
| Graft manipulation (e.g., selective T-cell depletion) | Graft manipulation (e.g., ex-vivo or in-vivo purging) |
| Avoid T-cell deplete grafts | |
| Use full ablative conditioning regimens | |
| Post-transplantation | |
| Immune modulation (e.g., tumor vaccines, interleukin-2) | Immune modulation (e.g., tumor vaccines, interleukin-2) |
| Maintenance therapy after HCT (e.g., tyrosine kinase inhibitors in CML) | Maintenance therapy after HCT (e.g., rituximab in low-grade lymphomas or IMiDs in myeloma) |
| Accelerated taper of immune suppression | |
| Prophylactic DLI (e.g., following T-depleted grafts in diseases at high-risk for relapse) | |
| Allogeneic HCT . | Autologous HCT . |
|---|---|
| Abbreviations: HLA indicates human leukocyte antigen; KIR, killer immunoglobulin-like receptor; GVHD, graft-versus-host disease; DLI, donor leukocyte infusions; CML, chronic myeloid leukemia; IMiD, immunomodulatory drug | |
| Pre-transplantation | |
| Therapy to achieve maximal remission pre-HCT | Therapy to achieve maximal remission pre-HCT |
| Consider HCT early in disease course for high risk diseases (e.g., poor cytogenetics, presence of minimal residual disease) | Consider HCT early in disease course for high risk diseases (e.g., early relapse, presence of minimal residual disease) |
| At transplantation | |
| Use novel therapies to maximize eradication of minimal residual disease (e.g., radioimmunotherapy, monoclonal antibodies) | Use novel therapies to maximize eradication of minimal residual disease (e.g., radioimmunotherapy, monoclonal antibodies) |
| Graft selection (e.g., HLA or KIR mismatched donors) | Graft selection (e.g., maximize CD34+ cell collection) |
| Graft manipulation (e.g., selective T-cell depletion) | Graft manipulation (e.g., ex-vivo or in-vivo purging) |
| Avoid T-cell deplete grafts | |
| Use full ablative conditioning regimens | |
| Post-transplantation | |
| Immune modulation (e.g., tumor vaccines, interleukin-2) | Immune modulation (e.g., tumor vaccines, interleukin-2) |
| Maintenance therapy after HCT (e.g., tyrosine kinase inhibitors in CML) | Maintenance therapy after HCT (e.g., rituximab in low-grade lymphomas or IMiDs in myeloma) |
| Accelerated taper of immune suppression | |
| Prophylactic DLI (e.g., following T-depleted grafts in diseases at high-risk for relapse) | |