From November 14 to 17, 2024, the Cellular Therapy and Immunotherapy Conference (CTI) took place in Hangzhou, China, attracting top experts, scholars, and industry leaders in the fields of cell and immunotherapy. This international event served as both an academic exchange platform and a showcase for groundbreaking scientific advancements.At the conference, Dr. Didier Blaise from the Hematology Institute at Aix-Marseille University in France delivered a presentation titled "The Impact of the Conditioning Regimen on the Success of Transplantation in Aged Patients." In an exclusive interview with Hematology Frontier, Professor Blaise shared his insights on balancing conditioning regimen intensity with the risk of complications, optimizing regimens to improve long-term survival and quality of life for elderly patients, and the future trends and challenges in this field.Q1: Conditioning regimens can affect the incidence of post-transplant complications. How can we balance the intensity of conditioning regimens with reducing the risk of complications for elderly patients?
Dr. Didier Blaise: Balancing the intensity of conditioning regimens and the risk of complications is a delicate issue, especially in elderly patients who generally have reduced recovery capacity compared to younger individuals. This has been a long-standing challenge in transplantation medicine.
Our primary goal is to lower the toxicity of conditioning regimens while maintaining their therapeutic effectiveness. Significant progress has been made in using reduced-intensity conditioning regimens, which aim to decrease cytotoxicity and reduce transplant-related toxicity. However, this approach carries the potential risk of less effective disease control.
To address this, extensive research is underway to identify the optimal balance for each individual patient. Our aim is to personalize treatment to effectively control the disease while minimizing the risk of complications. This is a complex process that requires careful consideration of factors such as patient age, overall health, and disease characteristics. With a deeper understanding of transplantation medicine and the accumulation of clinical experience, we are confident in our ability to progressively find the best conditioning regimens for elderly patients.
Q2: What is the impact of optimized conditioning regimens on the long-term survival and quality of life of elderly patients after transplantation? Could you share some findings or observations?
Dr. Didier Blaise: Optimizing conditioning regimens is crucial. When discussing transplantation, we are inherently talking about long-term outcomes and quality of life, particularly for elderly patients who often have underlying comorbidities, varying biological characteristics, and reduced physical resilience.
While conditioning regimens are pivotal for ensuring graft function and controlling disease progression, they are not the only factor influencing long-term outcomes. Post-transplant treatment plays a critical role, particularly in improving quality of life. By reducing the toxicity associated with the initial phase of transplantation, we can significantly enhance patients’ quality of life.
As part of the transplant care team, we have a responsibility to ensure that patients receive comprehensive care after transplantation to improve their overall well-being. Our research and clinical practice have shown that a holistic approach—considering both the conditioning regimen and post-transplant treatment—can provide safer and more effective transplant solutions for elderly patients.
Q3: With advancements in medical science, conditioning regimens continue to evolve. What new trends or challenges do you foresee in conditioning regimens for elderly patients?
Dr. Didier Blaise: I must emphasize once again that focusing solely on conditioning regimens is not a comprehensive strategy. Transplantation should be viewed as a holistic process, with conditioning regimens playing a critical role. The goal is to construct a strategy that ensures patient survival, provides effective disease control, and maintains a good quality of life.
This involves not only optimizing what happens during transplantation but also considering pre-transplant measures. By distributing the intensity of anti-cancer treatment across different phases—before, during, and after transplantation—we can reduce patient burden while improving treatment outcomes.
I believe this comprehensive approach, which we are already applying in clinical practice, will remain a key trend in the future. As we continue to refine this process, we aim to achieve better results for elderly patients undergoing transplantation.
Conclusion
Dr. Didier Blaise’s insights shed light on the evolving landscape of conditioning regimens for elderly transplant patients. Balancing regimen intensity to minimize complications while maintaining therapeutic efficacy remains a crucial challenge. Optimized regimens not only improve long-term survival rates but also significantly enhance the quality of life for elderly patients.
By taking a holistic approach to transplantation—incorporating pre-transplant, peri-transplant, and post-transplant strategies—researchers and clinicians are paving the way for safer and more effective treatments. As advancements in transplantation medicine continue, we look forward to further breakthroughs that will bring new hope to elderly patients worldwide.
About Dr. Didier Blaise
- Internationally renowned expert in hematopoietic stem cell transplantation and cellular immunotherapy
- Director of the Hematology and Bone Marrow Transplant and Cellular Therapy Program at Paoli Calmettes Institute, Aix-Marseille University
- Medical Director of the Department of Hematology
- Member of the European Society for Medical Oncology (ESMO) and the European Hematology Association (EHA)
