Is hematopoietic stem cell transplantation still relevant in the new era of immunotherapy?

Hematopoietic stem cell transplantation (HSCT), including autologous (auto-HSCT) and allogeneic (allo-HSCT), remains a key curative therapy for hematologic malignancies such as leukemia, lymphoma, and multiple myeloma.Although immunotherapy (monoclonal antibodies, CAR-T cells) has revolutionized treatment, HSCT retains its relevance, particularly in high-risk or refractory patients.HSCT has evolved with advances such as reduced-intensity conditioning, post-transplant cyclophosphamide, and haploidentical donors, expanding its accessibility.However, challenges persist, including toxicity, graft-versus-host disease, and relapse.In acute myeloid leukemia and myelodysplastic syndromes, allo-HSCT remains standard for high-risk cases, while in acute lymphoblastic leukemia, its use has declined due to targeted therapies and CAR-T cell therapy, but it remains crucial for high-risk and relapsed disease.In many B-cell lymphomas, CAR-T therapies are displacing auto-HSCT in high-risk relapsed or refractory disease, but allo-HSCT remains an option for post-CAR-T relapses.In multiple myeloma, auto-HSCT remains first-line standard, whereas allo-HSCT has a limited role.HSCT and immunotherapy are complementary, with HSCT maintaining a central role in high-risk di-seases or when novel therapies fail.Advances in both fields continue to refine treatment strategies, improving long-term outcomes for patients.