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Reduced-intensity conditioned allogeneic SCT in adults with AML

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Abstract

AML is currently the most common indication for reduced-intensity conditioned (RIC) allo-SCT. Reduced-intensity regimens allow a potent GVL response to occur with minimized treatment-related toxicity in patients of older age or with comorbidities that preclude the use of myeloablative conditioning. Whether RIC SCT is appropriate for younger and more standard risk patients is not well defined and the field is changing rapidly; a prospective randomized trial of myeloablative vs RIC (BMT-CTN 0901) was recently closed when early results indicated better outcomes for myeloablative regimens. However, detailed results are not available, and all patients in that study were eligible for myeloablative conditioning. RIC transplants will likely remain the standard of care as many patients with AML are not eligible for myeloablative conditioning. Recent publication of mature results from retrospective and prospective cohorts provide contemporary efficacy and toxicity data for these attenuated regimens. In addition, recent studies explore the use of alternative donors, introduce regimens that attempt to reduce toxicity without reducing intensity, and identify predictive factors that pave the way to personalized approaches. These studies paint a picture of the future of RIC transplants. Here we review the current status of RIC allogeneic SCT in AML.

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Acknowledgements

We wish to acknowledge the Center for International Blood and Marrow Transplant Research for providing data on the use of reduced-intensity transplants in AML. This work was supported in part by the Margie and Andy Rooke Fund for Leukemia Research, The Greg Wolf Fund and by grants from the National Cancer Institute (CA178202), the Conquer Cancer Foundation (Career Development Award), the National Marrow Donor Program (Amy Strelzer Manasevit Award) and the Commonwealth of Pennsylvania (CURE Program).

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Reshef, R., Porter, D. Reduced-intensity conditioned allogeneic SCT in adults with AML. Bone Marrow Transplant 50, 759–769 (2015). https://doi.org/10.1038/bmt.2015.7

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