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تسجيل

Transplantation Regimen Intensity in Acute Myeloid Leukemia

المؤلف:  Hoffman, R., Benz, E. J., Silberstein, L. E., Heslop, H., Weitz, J., & Salama, M. E.

المصدر:  Hematology : Basic Principles and Practice

الجزء والصفحة:  8th E , P1005

2026-10-27

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Myeloablative HSCT remains the standard of care for younger adults with AML. However, treatment-related mortality after MAC remains appreciable. Lower-intensity regimens offering less treatment-related toxicity are gaining in popularity. One report retrospectively compared RIC transplantation with chemotherapy in high-risk AML on a donor versus no-donor basis. They identified a leukemia-free survival benefit in the donor group (54% vs. 30%, P = .01). This indicates that both MAC and RIC HSCT offer antileukemic benefit compared to non-transplant therapies.

Several groups compared MAC versus RIC transplantation, documenting similar overall and leukemia-free survival, with some reporting lower treatment-related mortality offset by increased relapse risk, especially for patients not in complete remission at the time of HSCT. A CIBMTR study compared 3731 MAC, 1041 RIC, and 407 non myeloablative (NMA) transplantations, reporting adjusted 5-year over all survival (OS) of 34%, 33%, and 26%, respectively. The authors concluded that, although NMA transplantation increased relapse and impaired survival, RIC and MAC regimens had similar overall and leukemia-free survival. While a small randomized trial documented similar outcomes of MAC versus RIC transplantation in AML-CR1,1 a larger prospective randomized trial of MAC versus RIC transplantation in AML or MDS patients closed after the accrual of 272 of planned 356 patients due to an increased relapse and impaired long-term survival in the RIC arm. Additionally, as discussed previously, post-hoc analysis of this study documented that ablative conditioning can offer therapeutic benefit for patients with detectable pre-transplant MRD, offering relapse protection and survival benefit compared to RIC HSCT.

RIC transplantation does, however, offer the option of curative allogeneic HSCT in older or sicker AML-CR patients for whom the toxicity of MAC transplantation might be prejudicial, especially if combined with novel approaches to augment the GVL effect in the peri- and post-transplant setting. Conversely, patients with good performance status but high AML relapse risk could be preferentially selected for MAC.