To promote innovation in China’s cell and immunotherapy fields, facilitate in-depth exchange on key scientific issues, share the latest clinical research progress, and advance global collaboration and clinical translation, the 2025 International Conference on Cell and Immunotherapy (CTI 2025)—jointly organized by Zhejiang University, the International Academy for Clinical Hematology (IACH), the Zhejiang Society of Immunology, and the Zhejiang Anti-Cancer Association, and hosted by the First Affiliated Hospital of Zhejiang University School of Medicine together with Liangzhu Laboratory—was held in Hangzhou, Zhejiang, from 13 to 16 November 2025.
During the conference, Oncology Frontier – Hematology Frontier invited Professor Ibrahim Yakoub-Agha, President-Elect of the European Society for Blood and Marrow Transplantation (EBMT) and a faculty member of Lille University Hospital in France, for an in-depth discussion on core issues in the management of myelodysplastic syndromes (MDS). The dialogue focused on the integration of genomics into clinical decision-making, optimization of allogeneic hematopoietic stem cell transplantation timing, and exploration of future therapeutic pathways, with the goal of providing cutting-edge international perspectives to inform clinical practice.
Q1、With genomic profiling increasingly informing risk stratification in MDS, how do you integrate mutation data with traditional scores such as IPSS-R when deciding treatment—particularly timing of allogeneic SCT? In settings where targeted agents or trials are available, how do you alter treatment sequencing?
Actually, NGS and gene mutations are very important nowadays in understanding MDS and managing patients. Hopefully, these techniques will be disseminated worldwide because, as I mentioned during the conference, IPSS-R is still a valid scoring system, but IPSS-M, which integrates gene mutations, may be a better system. We can now break down the patient population into six categories, while still retaining the lower-risk, higher-risk, and intermediate-risk stratifications. This is important at the initial stage because we can reclassify some patients and decide whether to perform transplantation or not as a treatment option, for instance.
Even after transplantation, we can follow up with those patients through these mutations. Currently, there is no true measurable residual disease (MRD) for MDS, but post-transplant NGS can assist with this. In a few cases, we can use some targeted molecules, as we now have inhibitors for IDH2, for example. For TP53 mutations, we do not have sufficient effective treatments, but perhaps we can achieve personalized treatment for MDS in the future. Currently, NGS helps us better classify patients, better determine the treatment plan, and may also support follow-up after transplantation.
Q2、Recent EBMT and some studies present differing views on transplant timing—particularly whether to offer early allo-HCT for lower/intermediate-risk patients who harbour adverse molecular markers or progressive cytopenias. Based on your transplant practice, could you describe your decision logic for patient selection, pre-transplant bridging?
So for patients aged less than 70 years old with no comorbidities and higher-risk MDS, we would recommend upfront transplantation. We are still hesitant regarding patients with intermediate-risk MDS, as well as some patients with low-risk or lower-risk MDS. As you mentioned, for those patients harboring these gene mutations, we sometimes switch to upfront transplantation instead of waiting for an increase in the number of blasts, etc., because we can foresee rapid disease progression, so we need to consider transplantation for these patients.
Q3、Looking forward，with emerging targeted agents, immunotherapies/cellular approaches, and advances in transplant-related complication management, which advances do you expect will most likely change MDS clinical pathways in the future? For clinicians and researchers, which evidence gaps should be prioritised?
This is a very important question. I don’t have a clear answer for this because we haven’t made that much progress right now. However, I can tell you that for patients with lower-risk MDS, we can now manage those patients better than in the past, and we can really provide them with treatment to reduce transfusion dependency, for instance, or effectively manage iron overload in those patients. For patients with higher-risk MDS, beyond transplantation, I really encourage our colleagues to include those patients in clinical trials whenever possible, because we really need to explore all these emerging new drugs to see if we can truly change the prognosis of this disease.
Expert Biography
- Since 2008, Professor Ibrahim Yakoub-Agha has served as Head of the Hematopoietic Stem Cell Transplantation and Cellular Therapy Unit at Lille University Hospital, France.
Within the EBMT, he has held several major leadership roles, including Chair of the Chronic Malignancies Working Party (CMWP) from 2018 to 2022.
- He currently serves as Chair of the EBMT Practice Harmonisation & Guidelines Committee.
- He is the former President of the French Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) (2012–2016).
- In academic publishing, he is Editor-in-Chief of the journal Current Research in Translational Medicine.
