Methods to prevent and treat relapse after hematopoietic stem cell transplantation with tyrosine kinase inhibitors, immunomodulating drugs, deacetylase inhibitors, and hypomethylating agents

Abstract

Relapse is a major cause of treatment failure after stem cell transplantation. Novel agents given as maintenance or preemptive post transplant were discussed at the 3^rd International Workshop on Biology, Prevention, and Treatment of Relapse after Stem Cell Transplantation in Hamburg/Germany in November 2016 under the auspices of EBMT and ASBMT. Maintenance therapy is started after SCT without detectable disease, while preemptive therapy is triggered by the detection of minimal residual disease (MRD). The maintenance approach treats all patients, and overtreats a significant amount. Maintenance therapy requires an agent without significant off-target toxicity. The preemptive approach only initiates therapy upon detection of MRD, while sparing further therapy to those who remain in remission. Preemptive strategies require sensitive and clinically reliable assays to detect MRD. Here current development of tyrosine kinase inhibitors (TKIs) immunomodulating drugs (IMiDs), deacetylase inhibitors, and hypomethylating agents were reviewed.