In this article focused on innovations in onco-hematology are highlighted the successes of immunotherapy, as well as current challenges of allogeneic hematopoietic stem cell transplantation.
The treatment of hematological malignancies has traditionally been dominated by chemotherapy or radiotherapy. The discovery of the cytogenetic and molecular bases of these diseases has paved the way for targeted therapies; more recently, the field of immunotherapy has emerged with the development of CAR-Ts, BiTEs, immunoconjugates, and checkpoint inhibitors. These innovations have enabled us to better understand the complex interactions between a patient's immune system and potential tumor cells. However, the idea of exploiting the patient's immune system in an attempt to control his disease is not a recent concept, since allogeneic haematopoietic stem cell transplantation is based on the principle of using graft’s T lymphocytes to eliminate the recipient's tumor cells.
To date, allogeneic hematopoietic stem cell transplantation remains a mainstay of therapeutic weapons in hematology. Moreover, there is a great deal of research being done to improve outcomes. In order to reduce the risk of relapse without increasing toxicity, conditioning regimens with reduced toxicity are becoming a new standard. Graft-versus-host disease would be better prevented by administering post-transplant cyclophosphamide. Finally, numerous post-transplant relapses are the consequence of immune escape. A better understanding of their mechanisms likely opens the way to new therapeutic strategies.
Key Words
Immunotherapy, CAR-Ts, BiTEs, immunoconjugates, checkpoint inhibitors, allograft, graft-versus-host disease