About this Research Topic
Allogeneic stem cell transplantation (allo-SCT) is the most effective curative option for many hematological malignancies, in particular for Acute Leukemias (AL).
Since the extensive use of allo-SCT worldwide, several important improvements have been carried out, with a significant amelioration of transplant-related outcomes: overall survival, disease-free survival, relapse incidence, non-relapse mortality, the incidence of acute and chronic graft versus host disease, graft and relapse-free survival, infections rate and control and quality of life. The direct consequence of this improvement of transplant machinery is the progressive use of allo-SCT worldwide and the increase in the number of allo-SCTs performed every year.
Nevertheless, there is still the need for further investigation regarding this treatment by the hematology community.
1. The donor algorithm search has significantly changed in most of the Transplant Centers, following the introduction of transplantation from an alternative donor (e.g. haploidentical donors)
2. The conditioning platforms have undergone a progressive re-definition, from the traditional myeloablative conditionings to the reduced toxicities and reduced intensity regimes
3. The upper limit of age suitable for allo-SCT has dramatically increased, up to 70-75 years
4. The GVHD prophylaxis has changed since the introduction of post-transplant cyclophosphamide in the haploidentical transplantation and we are expecting important changes with the use of new drugs (e.g. JAK-2 inhibitors)
5. The viral management, in particular the CMV management, is ready to change with the introduction of letermovir for CMV prophylaxis in CMV positive recipients
6. Similarly, bacterial and fungal management is improving with the introduction of new antimicrobial therapies (e.g. new antifungal drugs)
7. The curability of the great majority of hematological disease with optimal use of allo-SCT has opened new horizons in the so-called “long term follow up and late complications prevention” of cured patients
8. The study of microbiomes and nutritional status of the patients before allo-SCT and during post-transplant follow up will be a mainstay in the next future
9. The immune reconstitution study with the different donors and the different GVHD prophylaxis platforms should be extensively studied
10. Strategies for relapse prevention are expected to improve with the use of adoptive immunotherapy and post-transplant maintenance (e.g. demethylating agents and Flt3 inhibitors in Als)
11. And last but not least, the advent of CAR-T cell therapy will open new questions; how will they change the treatment algorithm of our patients and the indications for allo-SCT
This Research Topic welcomes submissions in the field of allo-SCT addressing the above topics in the form of Original Research and Review Articles.
Keywords: Allogenic Stem Cell Transplantation, Acute Leukemias, hematological malignancies, Treatments and Curability
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