Myeloablative vs. Reduced Intensity Conditioning for Hematopoietic Cell Transplantation in Acute Myeloid Leukemia and Myelodysplastic Syndromes—Long Term Follow up of BMT CTN 0901 Clinical Trial

Abstract Background : Several prospective randomized trials comparing conditioning intensity prior to allogeneic hematopoietic cell transplantation (HCT) have been performed with conflicting results. While reduced intensity conditioning (RIC) leads to lower treatment-related mortality (TRM) this is offset by higher rates of relapse. Long term follow-up of randomized comparative trials are limited. Here we present long term follow up of a randomized comparison of myeloablative conditioning (MAC) compared to RIC prior to HCT for acute myeloid leukemia (AML) or myelodysplasia (MDS). Objective : Long-term comparative analysis of overall survival, relapse and relapse-free survival were performed. Study Design : Patients aged 18-65 with Results : The median follow-up of the entire cohort is 51 months. At 4-years, the TRM was 25.1% for MAC compared to 9.9% for RIC, p Conclusions : Patients who received MAC were at higher risk of late TRM compared to patients who received RIC; however due to exceedingly high rates of relapse in the RIC arm the overall survival remained significantly better for patients who received MAC. Among patients with MDS or AML eligible for either MAC or RIC regimens, long-term follow up demonstrates a survival advantage for patients who received MAC.