2026 Tandem Meetings Transplantation and Cellular Therapy Meetings of ASTCT® and CIBMTR®

Sanja Zepcan, PharmD, BCPS, BCOP, Clinical Pharmacy Specialist - Hematology/Oncology Bone Marrow Transplant and Cellular Therapy, Loyola University Medical Center

Introduction

The Tandem Meetings 2026, jointly hosted by the American Society for Transplantation and Cellular Therapy (ASTCT®) and the Center for International Blood and Marrow Transplant Research (CIBMTR®), brought together a multidisciplinary audience to highlight advances in hematopoietic cell transplantation (HCT) and cellular therapy. This annual meeting continues to serve as a platform for dissemination of practice-changing data and evolving standards in both clinical and translational care.

Pharmacy-focused sessions emphasized optimization of toxicity management, infection prevention, and integration of emerging therapies into practice. Key themes included immune effector cell–associated complications, supportive care standardization, pharmacogenomics implementation, and evolving post-transplant strategies. The following highlights summarize selected presentations with direct relevance to oncology pharmacy practice.

Highlight 1: Infection Risk and Management Following CAR-T Therapy

In this session, Dr. Jamie Marchesseault, Dr. Natalie Brumwell, and Dr. Mary McGann highlighted the multifactorial drivers of infection risk following CAR-T therapy, emphasizing the interplay between immune effector cell toxicities and their management. Cytokine release syndrome (CRS) emerged as both a marker of immune activation and a predictor of infection risk, with increasing severity correlating with higher rates of infectious complications. Importantly, treatment strategies for CRS significantly influence this risk.

Corticosteroids were identified as a major contributor to infection due to their broad immunosuppressive effects, with increased risk of invasive fungal infections, viral reactivation (e.g., HSV, CMV), and Pneumocystis jirovecii pneumonia. In contrast, targeted therapies such as tocilizumab (IL-6 inhibition) and anakinra (IL-1 blockade) have not consistently demonstrated increased infection risk, supporting their preferential use when appropriate.

Immune effector cell–associated hematotoxicity (ICAHT), particularly prolonged neutropenia, was strongly associated with severe infections and increased non-relapse mortality, reinforcing hematologic recovery as a key determinant of outcomes. Management strategies include early empiric antimicrobial therapy for febrile episodes given the difficulty distinguishing CRS from infection and implementation of risk-adapted prophylaxis.

Hypogammaglobulinemia due to B-cell aplasia was also highlighted as a contributor to infection risk. Routine IgG monitoring and intravenous immunoglobulin (IVIG) replacement,commonly initiated at IgG <400 mg/dL or with recurrent infections,are important supportive care measures.

Overall, optimizing outcomes requires balancing toxicity management with proactive infection prevention with pharmacists playing a central role in supportive care strategies.

Highlight 2: Medical Cannabis Use in HCT Patients

In this session, Dr. Kali Ditolla provided a focused review of the evolving role of medical cannabis in hematopoietic cell transplantation (HCT), emphasizing critical safety considerations in this highly vulnerable population. Cannabis-derived cannabinoids, primarily tetrahydrocannabinol (THC) and cannabidiol (CBD), are increasingly used for symptom management (e.g., nausea, appetite, pain) yet their pharmacologic complexity introduces significant risks in transplant care.

Both THC and CBD are metabolized through – and can inhibit – cytochrome P450 enzymes (notably CYP3A4 and CYP2C19), creating clinically meaningful drug–drug interactions. These interactions may complicate concomitant treatment with narrow therapeutic index medications such as tacrolimus, cyclosporine, sirolimus, and azole antifungals, potentially leading to supratherapeutic levels and toxicity. Additionally, concerns exist for altered metabolism of conditioning agents like busulfan, where variability in exposure may impact efficacy and toxicity.

The session strongly recommended avoiding cannabis during conditioning and early post-transplant immunosuppression due to compounded risks of pharmacokinetic variability, additive immunosuppression, and potential infectious complications – particularly with inhaled products that may expose patients to fungal contaminants. Product inconsistency and lack of regulatory standardization further complicate safe use.

Practical strategies include routine screening for cannabis use, patient-centered counseling, and implementation of a washout period (approximately ≥8 days for chronic users) prior to transplant when feasible. If use cannot be avoided, non-inhaled formulations are preferred to reduce infectious risk.

Overall, Dr. Ditolla emphasized the need for standardized institutional guidance and proactive pharmacist involvement to mitigate risks, ensure medication safety, and support informed decision-making in HCT patients.

Highlight 3: Pharmacogenomics Implementation in Transplant and Cellular Therapy

In this session, Dr. Susie Long outlined a practical framework for integrating pharmacist-led pharmacogenomics (PGx) services into transplant and cellular therapy programs, emphasizing the growing role of precision medicine in optimizing complex immunosuppressive and anti-infective regimens. Implementation begins with prioritizing high-impact, clinically actionable gene–drug pairs.Of particular interest are medications with narrow therapeutic indices such as tacrolimus (e.g., CYP3A5) and voriconazole (e.g., CYP2C19), where genetic variability significantly influences drug exposure, toxicity risk, and time to therapeutic levels.

Successful integration requires the development of standardized, interdisciplinary workflows that incorporate PGx testing into pre-transplant evaluation or early post-transplant care. This includes coordination between pharmacy, physicians, laboratory services, and informatics teams to ensure timely testing, result interpretation, and clinical application. Embedding PGx results into the electronic health record with clinical decision support tools was highlighted as a key strategy to facilitate real-time use at the point of prescribing.

Importantly, Dr. Long emphasized that not all genetic findings are clinically actionable. Institutions must critically assess the evidence supporting each gene–drug interaction, focusing on validated guidelines (e.g., CPIC) and demonstrated clinical utility before broad implementation. Variability in testing platforms, results reporting, and interpretation remains a barrier, underscoring the need for institutional standardization.

Pharmacists are uniquely positioned to lead PGx initiatives through protocol development, provider education, and individualized patient care. Their expertise in pharmacokinetics and therapeutics enables them to translate complex genomic data into actionable recommendations, ultimately improving safety, efficacy, and personalization of transplant care.

Highlight 4: Evolving Strategies in Post-Transplant Multiple Myeloma Management

Dr. Pearl Rajan Abraham and Dr. Issam Hamadeh delivered a comprehensive update on maintenance strategies following autologous stem cell transplantation (ASCT) in multiple myeloma, emphasizing a shift toward more personalized, response-adapted approaches. While lenalidomide continues to serve as the backbone of maintenance therapy due to its well-established progression-free and overall survival benefits, emerging evidence supports intensification with combination strategies, particularly the addition of anti-CD38 monoclonal antibodies such as daratumumab to deepen responses.

Data presented highlighted improved rates of minimal residual disease (MRD) negativity and sustained disease control with combination maintenance, suggesting that achieving deeper responses post-transplant translates into better long-term outcomes. MRD assessment was underscored as a powerful prognostic and potentially actionable biomarker, with growing interest in using MRD status to tailor maintenance duration and intensity – escalating therapy in MRD-positive patients while potentially de-escalating in those with sustained MRD negativity.

However, significant challenges remain, particularly in high-risk cytogenetic populations, where optimal maintenance strategies are not yet clearly defined. Ongoing studies are evaluating the incorporation of novel therapies – including CAR T-cell therapy, bispecific antibodies, antibody-drug conjugates, and CELMoDs (Cereblon E3 Ligase Modulatory Drugs) – earlier in the disease course to improve durability of response.

Overall, this session highlighted a paradigm shift from a “one-size-fits-all” approach toward risk-adapted, MRD-guided maintenance strategies with the goal of balancing efficacy, toxicity, and quality of life in the post-transplant setting.

Highlights 5: ReviTILizing Tumor Infiltrating Lymphocytes (TIL) and IL-2 in Melanoma

Dr. Charlene Kabel provided a practical and clinically grounded overview of tumor-infiltrating lymphocyte (TIL) therapy combined with high-dose interleukin-2 (IL-2), highlighting its re-emergence as a promising option in advanced melanoma. TIL therapy leverages autologous lymphocytes harvested from the tumor microenvironment, expanded ex vivo, and reinfused following lymphodepleting chemotherapy to enhance antitumor immune response.

Clinical data demonstrated durable response rates in heavily pretreated melanoma populations, including patients previously exposed to immune checkpoint inhibitors. The addition of IL-2 remains critical to support T-cell expansion and persistence, though it contributes significantly to treatment-related toxicity.

Dr. Kabel emphasized that successful delivery of TIL therapy requires intensive supportive care infrastructure. Key toxicities include cytokine-mediated effects such as hypotension, capillary leak syndrome, fever, and organ dysfunction, particularly during IL-2 administration. Close monitoring in specialized centers, often with ICU-level support, is essential during the acute treatment phase.

From a pharmacy perspective, the session highlighted the importance of proactive toxicity management, including fluid balance optimization, vasopressor support, and timely recognition of complications. Coordination of lymphodepleting chemotherapy, cell infusion logistics, and IL-2 dosing requires multidisciplinary collaboration.

As TIL therapy continues to re-enter the melanoma treatment landscape, oncology pharmacists play a critical role in ensuring safe administration, managing high-risk toxicities, and educating care teams on this complex but potentially transformative immunotherapeutic approach.

Conclusion

The Tandem Meetings 2026 highlighted the rapid evolution of transplantation and cellular therapy, marked by increasing therapeutic complexity and a growing emphasis on precision, safety, and individualized care. Across sessions, a consistent theme emerged: optimizing patient outcomes requires not only effective therapies but also proactive, risk-adapted supportive care strategies.

Advances in CAR-T therapy continue to redefine treatment paradigms, while simultaneously underscoring the importance of managing associated toxicities, cytopenias, and infectious risks. Emerging considerations – including medical cannabis use and pharmacogenomics – further illustrate the expanding scope of factors influencing patient safety and therapeutic outcomes. In parallel, post-transplant management in multiple myeloma is shifting toward MRD-guided and combination-based approaches, reflecting a broader move toward personalized treatment strategies. Additionally, the re-emergence of therapies such as TIL highlights ongoing innovation beyond traditional modalities.

Collectively, these developments reinforce the integral role of oncology pharmacists in transplant and cellular therapy. Through expertise in toxicity management, drug interactions, precision medicine, and interdisciplinary coordination, pharmacists are essential in translating evolving evidence into safe, effective, and patient-centered care.

2026 Tandem Meetings Transplantation and Cellular Therapy Meetings of ASTCT® and CIBMTR®

Introduction

Highlight 1: Infection Risk and Management Following CAR-T Therapy

Highlight 2: Medical Cannabis Use in HCT Patients

Highlight 3: Pharmacogenomics Implementation in Transplant and Cellular Therapy

Highlight 4: Evolving Strategies in Post-Transplant Multiple Myeloma Management

Highlights 5: ReviTILizing Tumor Infiltrating Lymphocytes (TIL) and IL-2 in Melanoma

Conclusion

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