Will an allogeneic transplant ever be considered at relapse?

Will an alginate transplant ever be considered at relapse?

So I think allogeneic transplant is a very controversial topic or treatment.

And I think there is still a role for allogeneic stem cell transplant, but it's a very small, specific indication or for a specific patient.

I don't think it's something where even when we talk about autologous stem cell transplant, you know, are you transplant eligible or not eligible. It's really there's a lot of, I think, decisions that have to go into an allogeneic transplant.

It's important to be at a center that is experienced with allogeneic stem cell transplants and allogeneic transplants, particularly in multiple myeloma. And then to really weigh the pros and cons of doing that kind of therapy, I think for a very select subgroup of patients, it may be a reasonable treatment to consider,

but I think we have a lot of really exciting new therapies, particularly things like CAR-T cell therapy, immunotherapy, where, you know, we're able to kind of keep pushing off this idea of using an allogeneic stem cell transplant.

I should tell you that our institution, we don't believe in allogeneic transplants. Too many complications, too much toxicity, especially long term chronic graft versus host disease. And we just don't think that the value, although there is some value in what we call graft versus myeloma effect, where you can cure myeloma with an allogeneic transplant. But we think the toxicities are too great for the risk.

but I think it's going to become an unimportant discussion because the newer therapies like CAR-T cell are actually a way of giving an allogeneic effect, a graft versus, if you will, the car being the graft myeloma effect with an autologous cell so that you don't have to worry about graft versus host disease or rejection of the graft.

So I think we've all recognized for decades now that there is an allogeneic effect of killing myeloma with somebody else's immune system. But I think we're in an era now where we can not use allogeneic transplant but used car T cells, which are in effect the same thing without the risk.

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