Considerations that influence the decision to initiate maintenance therapy after allogeneic HCT
| Factor . | Considerations . |
|---|---|
| Underlying disease | Higher rates of relapse for high-risk disease characteristics (elevated blast count, specific cytogenetic or molecular abnormalities) compared with the absence of high-risk disease factors |
| Disease status at transplant | Higher rates of relapse in acute leukemia when measurable disease detectable at transplant compared with undetectable disease |
| Intensity of the conditioning regimen | Higher rates of relapse with reduced intensity conditioning therapy compared with myeloablative conditioning |
| Post-HCT complications | Slow hematopoietic recovery or ongoing toxicities (GVHD, infection, organ dysfunction) limit ability to initiate maintenance therapies |
| Characteristics of therapeutic agent | Therapeutic agent must address underlying disease biology (targeted agents for identified mutations or hypomethylating agent-based approached for myeloid neoplasms) and have favorable toxicity profile in post-HCT setting |
| Factor . | Considerations . |
|---|---|
| Underlying disease | Higher rates of relapse for high-risk disease characteristics (elevated blast count, specific cytogenetic or molecular abnormalities) compared with the absence of high-risk disease factors |
| Disease status at transplant | Higher rates of relapse in acute leukemia when measurable disease detectable at transplant compared with undetectable disease |
| Intensity of the conditioning regimen | Higher rates of relapse with reduced intensity conditioning therapy compared with myeloablative conditioning |
| Post-HCT complications | Slow hematopoietic recovery or ongoing toxicities (GVHD, infection, organ dysfunction) limit ability to initiate maintenance therapies |
| Characteristics of therapeutic agent | Therapeutic agent must address underlying disease biology (targeted agents for identified mutations or hypomethylating agent-based approached for myeloid neoplasms) and have favorable toxicity profile in post-HCT setting |