HCT Across MDS Genetic Subtypes
Explore Cell Therapy podcast season 2, episode 14
In this two-part "Explore Cell Therapy" podcast episode, Coleman Lindsley, MD, PhD, and Corey Cutler, MD, MPH, FRCP(C), discuss recent and evolving research supporting the broad benefits of hematopoietic cell transplant (HCT) across all genetic subtypes of myelodysplastic syndrome (MDS), including for patients with high-risk mutations like TP53.
Experts dive into the shift towards precision medicine and the crucial role of genetic mutations in understanding patient outcomes. We explore major advances in transplant for older patients with MDS, highlighting the recent expansion of coverage through the Centers for Medicare and Medicaid Services (CMS), a significant milestone driven by recent studies that demonstrate the safety and efficacy of HCT in patients over 65 years old. Experts stress the importance of early consultation to optimize treatment decisions and ensure equity in access to HCT for older patients in need of a curative treatment option.
Key takeaways
- Advances in HCT for older patients: The past 10-20 years have seen significant improvements in transplant techniques, allowing for safer and more effective transplants in older patients. These advances include reduced intensity treatment regimens, novel graft-versus-host disease (GVHD) prevention strategies and improved supportive care, making transplant a viable option for older patients across all transplantable diseases.
- CMS coverage expansion for MDS and HCT: CMS has recently expanded coverage for older patients with MDS, a significant achievement in the field. This decision was influenced by studies showing that transplant outcomes in patients over 65 are comparable to those in younger patients, challenging the notion that age alone should determine eligibility for transplant.
- Broad applicability of HCT across MDS genetic subtypes: The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1102 study’s genetic sub-analysis revealed that having a donor and undergoing transplant significantly improved outcomes across all genetic subtypes of MDS, including those with challenging mutations like TP53. This finding emphasizes that even high-risk genetic profiles should not preclude transplant.
- Impact of TP53 mutations on HCT outcomes: While TP53 mutations are associated with poorer outcomes, the analysis showed that patients with these mutations still benefit from transplant, with a notable percentage achieving long-term survival. This challenges previous biases against referring TP53-mutated patients for transplant evaluation.
- Importance of early transplant consult: Early transplant consultation for MDS patients is crucial, even if immediate transplant isn’t required. This allows for early discussions about donor options and informed decision-making, ensuring patients are well-prepared should their clinical situation change.
This episode's expert guests
Coleman Lindsley, MD, PhD
Director, Clinical Genomics in Hematologic Malignancies
Dana-Farber Cancer Institute
Associate Professor, Harvard Medical School
Corey Cutler, MD, MPH, FRCP(C)
Director, Stem Cell Transplantation
Dana-Farber Cancer Institute President, ASTCT
Professor, Harvard Medical School
Dr. Lindsley acts as director of the Edward P. Evans Center for Myelodysplastic Syndrome at Dana-Farber Cancer Institute. His research focuses on the biology and treatment of myeloid malignancies, emphasizing familial leukemia predisposition and understanding donor and recipient factors that drive clinical outcomes after transplantation.
Dr. Cutler is a long-standing researcher and transplant physician, specializing in the prevention and treatment of acute and chronic GVHD. He studies the role and timing of transplantation for MDS and is a contributing author on more than 300 peer-reviewed publications.
Featured articles and clinical trials discussed in this episode
- Allogeneic Hematopoietic Cell Transplantation Improves Outcome in Myelodysplastic Syndrome Across High-Risk Genetic Subgroups: Genetic Analysis of the Blood and Marrow Transplant Clinical Trials Network 1102 Study (Journal of Clinical Oncology, August 2023)
- Biologic Assignment Trial of Reduced-Intensity Hematopoietic Cell Transplantation Based on Donor Availability in Patients 50-75 Years of Age With Advanced Myelodysplastic Syndrome (Journal of Clinical Oncology, June 2021)
- Clinical and genetic predictors of prognosis in myelodysplastic syndromes (Haematologica, June 2014)
- Molecular International Prognostic Scoring System for Myelodysplastic Syndromes (New England Journal of Medicine, July 2022)
- Clinical and Genomic-Based Decision Support System to Define the Optimal Timing of Allogeneic Hematopoietic Stem-Cell Transplantation in Patients With Myelodysplastic Syndromes (Journal of Clinical Oncology, May 2024)
Resources for hematology/oncology and transplant physicians
This program for hematology/oncology practices provides free HLA typing for patients and their family members in the community before they reach the transplant center.
This new and improved app features our latest HCT Consultation Timing Guidelines, Post-Transplant Care Guidelines, tips to help identify GVHD, CME opportunities and more.
Transplant Center Directory for hematology/oncology physicians
This searchable database provides details on the transplant centers, such as center contact information, number of transplants by cell source, patient survival information and more.
CIBMTR Summary Slides and Reports
CIBMTR data on outcomes and trends are summarized and made available for clinical decision-making, presentations and research planning.
Resources for your patients
The NMDP Patient Support Center provides support, information and resources for transplant patients, caregivers and families. All our programs and resources are free.
Jason Carter Clinical Trials Search and Support Program
The Clinical Trials Search and Support Program helps patients find and join clinical trials through one-on-one support, an easy-to-navigate website and financial assistance to help patients pay for travel costs to participate in a clinical trial.