Dickran Kazandjian, MD retweeted
Jun 13
Asct no survival benefit even in older regimens. 100% agree I think the bispecific versus asct will be the end of asct. Cobalt, ElLen, EMN rami trial all questioning this, and I cannot imagine they will not be superior.
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Chidambara .ML. retweeted
🦴 MajesTEC-4 (a post transplant maintenance trial) May Delay the Retirement of ASCT 😱
Fellow:
“Professor, with CARTITUDE-4, MajesTEC-3, MajesTEC-9, MonumenTAL-3, and future frontline studies such as MajesTEC-5/7, I think High-Dose Melphalan AutoSCT will be honorably discharged soon!”
Professor:
“Not so fast.”
The updated MajesTEC-4 Safety Run-In (SRI) cohorts reported:
✅ Nearly 100% CR
✅ Nearly 100% MRD negativity
✅ Median PFS not reached
✅ Only 3 progressions reported
Importantly, MajesTEC-4 remains an ongoing Phase III study and the randomized portion is still actively enrolling.
Still, these data raise an interesting biological question.
For years, we viewed AutoSCT primarily as a delivery system for high-dose melphalan.
Perhaps it is more than that.
Perhaps HDM AutoSCT serves as a platform for the next generation of immunotherapy through:
🦴 Deep cytoreduction
🦴 Marrow niche disruption
🧬 Immune ecosystem reset
🚀 An optimal setting for maintenance immunotherapy
First it was lenalidomide maintenance.
Now it may be teclistamab ± lenalidomide.
Whether this hypothesis is correct remains to be proven, but MajesTEC-4 certainly makes the discussion more interesting.
Perhaps AutoSCT is not the treatment.
🚀 Perhaps AutoSCT is the launchpad.
AutoSCT may stay around longer than me. 😄
#EHA2026 #Myeloma #Bispecifics
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🧬 ASCT Conditioning Regimens in R/R Lymphoma (n=80)
👥 Regimens compared:
• BeEAM (n=16)
• CBV (n=12)
• CEAC (n=16)
• SEAM (n=36)
⚠️ Toxicity profiles differed significantly:
💓 SEAM: Highest BNP elevation (61.1%, p=0.040)
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Dr. Paul De Santis, PharmD retweeted
Jun 13
DRVD—ASCT—-DR x 2 years (may continue Len till month 36 but will then stop) or enroll in @CCTG MY.13. Upon relapse go to Tec/dara. I will likely be retired by the time pts relapse off first two lines :) @MyelomaCanada I need tec/dara asap.
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🦴 AutoSCT for mantle cell lymphoma may be approaching retirement, but I am not convinced it is dead yet.
TRIANGLE and EA4151 have clearly shown that ASCT should no longer be automatic for every patient. However, neither study was designed or powered to definitively answer whether ASCT still benefits biologically high-risk subsets.
In TRIANGLE:
• 58% of patients had low-risk MIPI
• Only 15% had high-risk MIPI
• TP53-mutated cases represented only ~4%
• Relatively few blastoid/pleomorphic cases
The recent EHA biomarker analysis is fascinating and suggests that much of the benefit of ibrutinib-containing therapy may be driven by TP53-mutated disease. If true, that is an important biological insight. But it does not necessarily answer whether ASCT remains valuable for TP53-wild-type patients, high MIPI disease, blastoid morphology, very high Ki-67, or MRD-positive patients.
EA4151 similarly demonstrated that MRD-negative patients in CR may not require ASCT. Yet that is a highly selected favorable-risk population.
Perhaps the real lesson is not that ASCT should retire, but that we finally need a biology-driven approach to determine who can safely avoid it.
For now, I would say:
❌ ASCT is no longer mandatory.
❌ ASCT is no longer the default.
✅ Whether ASCT still benefits selected high-risk patients remains an open question.
#lymphoma #MCL #EHA2026
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I could not enroll patients to a bispecific vs ASCT trial at this point. I can’t claim to have equipoise just to satisfy my curiosity.
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Olga retweeted
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