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Transplantation and Cellular Therapy for Older Adults—The MSK Approach

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Abstract

Purpose of Review

Hematologic malignances more commonly affect older individuals and often present with advanced, higher risk disease than younger patients. Allogeneic and autologous hematopoietic cell transplantation is well-established treatment modalities with curative potential following either frontline treatments for these diseases or salvage therapy in the relapsed or refractory setting. More recently, novel cellular immunotherapy such as chimeric antigen receptor T-cell therapy has been shown to lead to high response rate and durable remission in many patients with advanced blood cancers.

Recent Findings

Given unique characteristics of older patients, how best to deliver these higher-intensity and time sensitive treatment modalities for them remains challenging. Moreover, their short-term and potential long-term impact on their functional status, cognitive status, and quality of life may be significant considerations for many older patients. All these issues contributed to the lack of access and significant underutilization of these potential curative treatment strategies.

Summary

In this review, we present up to date evidence to support potential benefits of transplantation and cellular therapy for older adults, their steady improving outcomes, and most importantly, highlight the use of geriatric assessment to help select appropriate older patients and optimize them prior to and following transplantation and cellular therapy. We specifically describe our approach at Memorial Sloan Kettering Cancer Center and encouraging early results from its implementation.

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Funding

Richard J. Lin is supported by American Society of Hematology and MDS Dresner Foundation. We acknowledge the MSK Cancer Center Support Core Grant (P30 CA008748).

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Authors and Affiliations

  1. Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Richard J. Lin, Parastoo B. Dahi, Ann A. Jakubowski & Sergio A. Giralt

  2. David H. Koch Center for Cancer Care, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, Room 21-142, New York, NY, 10022, USA

    Richard J. Lin

  3. Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Beatriz Korc-Grodzicki & Armin Shahrokni

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  1. Richard J. Lin
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Correspondence to Richard J. Lin.

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All authors declare no potential conflicts of interest related to this manuscript.

Richard J. Lin is a consultant of Kite Pharmaceuticals and Magenta Pharmaceutics.

Parastoo B. Dahi has served on an advisory board for Kite (Gilead).

Sergio A. Giralt has served as a consultant for Amgen, Actinium, Celgene, Johnson & Johnson, Jazz Pharmaceutical, Takeda, Novartis, Kite, and Spectrum Pharma and has received research funding from Amgen, Actinium, Celgene, Johnson & Johnson, Miltenyi, and Takeda.

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Lin, R.J., Dahi, P.B., Korc-Grodzicki, B. et al. Transplantation and Cellular Therapy for Older Adults—The MSK Approach. Curr Hematol Malig Rep 19, 82–91 (2024). https://doi.org/10.1007/s11899-024-00725-y

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