Impact of Transplant Timing in MDS Treatment | Benajmin Rolles, MD | #ASH24

So the time to transplant was already published previously by Tentory et al, by a paper that was published this year in the journal JCO. And in this paper, the authors looked at the timing of transplants. So if the timing is relevant, dependent on the disease risk and the find, the main finding of the paper was that higher risk patients, it seems like, need to undergo transplant sooner compared to lower risk patients where, a transplant can be delayed with without impairing, survival.

That's the main point of our project. So we tried to coupled treatment response to baseline molecular risk. So in clinic we often evaluate response after treatment. And we looked if that's important within all disease risk groups. So iPSCs would be a disease risk group. And we found out in our study that in patients that, doesn't go or didn't go to transplantation, the evaluation of response is very important as we assumed.

But in patients that undergo to transplant, it was not so important as we expected. So it's very hard to draw a clear conclusion from our study because it's retrospective. It's especially when patients are listening. Now, I have to emphasize that this study has a lot of caveats, so we have to focus on that in more detail.

We have to do randomized trial to really address this question. But with this, limitations that our study have, we found that we maybe have to, also consider other factors not only response for patients that go into transplantation. And one of these factors is, for example, then maybe the time to transplant and or maybe different treatment drugs that we use or treatment combinations.

That's a good question that I cannot answer with the study right. We have to follow evidence and evidence based. Yeah. Evidence based medicine. So the data so there is not such a study that I know of. So we still don't know really. Exactly. Or at least there's no studies showing that there's a real benefit of treatment before transplant or without treatment.

So that's still something we have to figure out. That's, that's a question we we still have to answer in the future. The maybe disappointing takeaway is that we still have to do more studies to really understand it and that maybe, some treatments do not really impact baseline molecular risk. So there's still a high need for new treatments in MDS.

The takeaway is that for high risk patients, transplant might be a very important factor in the treatment itself, the timing. And if there should be a treatment before transplant or not. Maybe the especially the question what treatment before transplant and if there should be a combination of different drugs that still has to be figured out in, future studies.

So I'm very much a basic lab researcher. I'm very much interested in new treatment strategies. So kind of developing new drugs, especially for MDS because there's a high need. So especially what I mentioned was baseline molecular risk. Even after transplant, we see that patients with a high risk still perform a little bit worse than patients with a lower risk.

So I think I'm very much interested in developing new drugs. But I would also be interested to see how the combination, for example, with hypomethylating agents and venetoclax before transplantation, if that really makes a difference.