New cancer therapies. Are haematopoietic cell transplants a dead duck?

Recent therapy advances for haematological cancers including new drugs and targeted and immune therapies raise the question whether there is a future for haematopoietic cell transplants. Although encouraging, the survival improvements achieved with these new modalities in persons who might otherwise receive a transplant are modest. Furthermore, these modalities are likely to be complementary, not competitive. For example, randomised trials in multiple myeloma, the most common transplants, indicate an ongoing role for transplant despite new anti-myeloma drugs. Targeted therapies in myeloid cancers are estimated to be effective in only about 10 percent of persons with these cancers. The potential impact of current immune therapies on transplant activity is also limited because: (1) they predominately target B-cell rather than myeloid cancers; (2) many successful immune therapy recipients subsequently receive a transplant; (3) considerable data indicate much of the efficacy of allotransplants results from allogeneic rather than cancer-specific immunity not expected to operate with current immune therapies; and (4) they are at an early development stage with unknown long-term safety and efficacy. These data suggest an ongoing role for haematopoietic cell transplants in diverse haematological and genetic disorders.