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To RIC or not to RIC: that is the question

Leukemia volume 29, pages 1450–1451 (2015)Cite this article

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In this issue of the journal, Russell et al.1 reports on the MRC's AML15 trial results evaluating whether a matched sibling (SIB) or unrelated donor (MUD) allogeneic stem cell transplantation (allo-SCT) for acute myeloid leukemia (AML) compared favorably with chemotherapy consolidation in 1st remission at intermediate or high risk of relapse. Some transplant recipients received conventional, standard myeloablative high-dose pre-transplant conditioning (MAC) and other reduced-intensity conditioning (RIC). The choice of whether to do a transplant and which pre-transplant conditioning regimen use was left to the physician’s choice. Moreover, not all subjects meant to receive a transplant of either type did so. Also, the study relied mainly on conventional cytogenetic analysis which may not be the most appropriate approach for risk assessment at the era of molecular biology and next-generation sequencing. These issues, of course, confound any critical analyses of the outcomes. Moreover, the sophisticated multiple statistical comparisons which did not attempt to include an ‘intent-to-treat’ analysis made the overall interpretation of results quite difficult.

Nevertheless, in this study it appeared that the use of RIC prior to allo-SCT significantly reduced relapse incidence and the 5-year overall survival from a SIB donor RIC allo-SCT was superior to RIC allo-SCT from a MUD owing to lower non-relapse mortality (NRM). Also, there was a survival benefit for RIC allo-SCT from a SIB donor over chemotherapy. Focusing on the age 35–44 group, patients given RIC allo-SCT enjoyed better outcomes compared with patients who received standard MAC allo-SCT.

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Acknowledgements

FM was supported by an educational grant from the ‘Association for Training, Education and Research in Hematology, Immunology and Transplantation’ (ATERHIT). We thank the ‘Association pour la Recherche sur le Cancer (ARC), the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’, the ‘Association Laurette Fuguain’, the ‘International Research Group on Unrelated Hematopoietic Stem cell Transplantation’ and the ‘Ligue contre le Cancer (Comités Départementaux de l’Inter région Grand-Ouest Bretagne, Centre, Pays-de-Loire, Poitou-Charentes)’, for their generous and continuous support for our clinical and basic research work. Our group is supported by several grants from the (Hospital Clinical Research Program from the French national cancer institute to MM).

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Authors and Affiliations

  1. Department of Hematology, Saint Antoine Hospital, Paris, France

    M Mohty & F Malard

  2. INSERM UMR 938, Paris, France

    M Mohty & F Malard

  3. Université Pierre et Marie Curie, Paris, France

    M Mohty & F Malard

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  1. M Mohty
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Correspondence to M Mohty.

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Mohty, M., Malard, F. To RIC or not to RIC: that is the question. Leukemia 29, 1450–1451 (2015). https://doi.org/10.1038/leu.2015.82

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