Strategies and Challenges for Pharmacological Maintenance Therapies after Allogeneic Hematopoietic Cell Transplantation

•Targeted agents have allowed the introduction of maintenance therapies after allogeneic hematopoietic cell transplantation•Pre-emptive and maintenance approaches have the potential to decrease disease relapse after hematopoietic cell transplantation•Well-designed clinical trials must be done to evaluate maintenance approaches

Disease relapse is a major barrier to successful allogeneic hematopoietic cell transplantation (HCT). Maintenance therapy administered after HCT is a promising strategy to attempt to reduce relapse and improve overall survival. However, many questions and challenges remain regarding this approach, including which patients should receive maintenance therapy, which agents should be used, what the ideal duration of therapy is, and what effect specific agents will have on toxicities, immunological reconstitution and graft-versus-host disease. Clinical trials are ongoing, which should help begin to address some of these issues and it is imperative that the transplantation community continues to collaborate in such trials to best answer these questions.