A phase III randomized trial presented at the ASH Annual Meeting has shown that although reduced-intensity regimens have lower treatment-related mortality (TRM), they also incur higher relapse rates. As a result, the researchers concluded that myeloablative regimens should be standard of care for those patients healthy enough to receive them. This Blood and Marrow Transplant Clinical Trials Network (BMT CTN) trial compared outcomes by conditioning intensity in 272 patients with myelodysplastic syndromes (n=54) or acute myeloid leukemia (n=218). At 18 months, in an intention-to-treat analysis, there was a trend for higher overall survival in patients on the myeloablative arm compared to patients in the reduced-intensity arm: 77.4% vs. 67.7% (p=0.07). Relapse in the reduced-intensity arm was 48.3% vs. 13.5% in the myeloablative arm (p<0.01), resulting in a higher relapse-free survival for patients in the myeloablative arm: 67.7% vs. 47.3% (p<0.01).
Higher Relapse-Free Survival with Myeloablative HCT in Patients with AML and MDS