[Integration of novel anti-tumor agents and allogeneic hematopoietic stem cell transplantation]

Allogeneic hematopoietic stem cell transplantation is a potentially curative therapy for acute leukemia and myelodysplastic syndromes; however, post-transplant relapse remains a major cause of treatment failure. In recent years, the emergence of novel therapeutic agents has reshaped treatment strategies in both the pre- and post-transplant settings. This review summarizes the roles of these agents in pre-transplant bridging and post-transplant maintenance therapy. In the pre-transplant setting, the use of venetoclax-based regimens, FLT3 inhibitors, and IDH inhibitors has improved treatment outcomes by enabling the achievement of measurable residual disease (MRD)-negative remission. In the post-transplant setting, as the cytotoxic effects of conditioning diminish, the risk of relapse increases, highlighting the importance of maintenance strategies using azacitidine and FLT3 inhibitors, as well as MRD-guided preemptive interventions. Future strategies should focus on MRD-guided and risk-adapted maintenance based on molecular risk and disease dynamics.