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hematopoietic cell transplantation in the era of chimeric antigen receptor T cells and checkpoint inhibitors

Ghosh, Arnaba,b; Politikos, Ioannisa,b; Perales, Miguel-Angela,b

doi: 10.1097/CCO.0000000000000408
HEMATOLOGIC MALIGNANCIES: Edited by Miguel A. Sanz
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Purpose of review For several decades, hematopoietic cell transplantation (HCT) has been considered the standard curative therapy for many patients with hematological malignancies. In addition to the cytotoxic effects of the chemotherapy and radiation used in the conditioning regimen, the benefits of HCT are derived from a reset of the immune system and harnessing the ability of donor T cells to eliminate malignant cells. With the dawn of the era of immunotherapies in the form of checkpoint inhibitors and chimeric antigen receptor (CAR) T cells, the role of HCT has evolved.

Recent findings Immunotherapy with checkpoint inhibitors is increasingly being used for relapsed Hodgkin and non-Hodgkin lymphoma after autologous HCT. Checkpoint inhibitors are also being tested after allogeneic HCT with observable benefits in treating hematological malignancies, but with a potential risk of increased graft versus host disease and transplant-related mortality. Immunotherapy with Cluster of differentiation 19 CAR T cells are powerful options with aggressive B-cell malignancies both for therapy and as induction leading to allogeneic HCT.

Summary Although immunotherapies with checkpoint inhibition and CAR T cells are increasingly being used to treat hematological malignancies, HCT remains a standard of care for most of the diseases with the best chance of cure. Combination of these therapies with HCT has the potential to more effectively treat hematological malignancies.

aAdult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center

bDepartment of Medicine, Weill Cornell Medical College, New York City, New York, USA

Correspondence to Miguel-Angel Perales, MD, Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA. Tel: +1 212 639 8682; fax: +1 212 717 3500; E-mail: peralesm@mskcc.org

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