Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

To RIC or not to RIC: that is the question

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

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

References

  1. Russell N, Kjeldsen L, Craddock C, Pagliuca A, Yin J, Clark R et al. A comparative assessment of the curative potential of reduced intensity allografts in acute myeloid leukaemia. Leukemia 2015; 29: 1478–1484.

    Article  CAS  Google Scholar 

  2. Mohty M, de Lavallade H, El-Cheikh J, Ladaique P, Faucher C, Furst S et al. Reduced intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia: long term results of a 'donor' versus 'no donor' comparison. Leukemia 2009; 23: 194–196.

    Article  CAS  Google Scholar 

  3. Versluis J, Labopin M, Niederwieser D, Socie G, Schlenk RF, Milpied N et al. Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission. Leukemia 2014; 29: 51–57.

    Article  Google Scholar 

  4. Baron F, Labopin M, Niederwieser D, Vigouroux S, Cornelissen JJ, Malm C et al. Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European group for blood and marrow transplantation. Leukemia 2012; 26: 2462–2468.

    Article  CAS  Google Scholar 

  5. McSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG et al. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood 2001; 97: 3390–3400.

    Article  CAS  Google Scholar 

  6. Slavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood 1998; 91: 756–763.

    CAS  Google Scholar 

  7. Mohty M, Apperley JF . Long-term physiological side effects after allogeneic bone marrow transplantation. Hematology Am Soc Hematol Educ Program 2010; 2010: 229–236.

    Article  Google Scholar 

  8. Mengarelli A, Iori A, Guglielmi C, Romano A, Cerretti R, Torromeo C et al. Standard versus alternative myeloablative conditioning regimens in allogeneic hematopoietic stem cell transplantation for high-risk acute leukemia. Haematologica 2002; 87: 52–58.

    CAS  Google Scholar 

  9. Kharfan-Dabaja MA, Labopin M, Bazarbachi A, Hamladji RM, Blaise D, Socie G et al. Comparing i.v. BU dose intensity between two regimens (FB2 vs FB4) for allogeneic HCT for AML in CR1: a report from the Acute Leukemia Working Party of EBMT. Bone Marrow Transplant 2014; 49: 1170–1175.

    Article  CAS  Google Scholar 

  10. Mohty M, Malard F, Blaise D, Milpied N, Furst S, Tabrizi R et al. Reduced-toxicity conditioning with fludarabine, once-daily intravenous busulfan, and antithymocyte globulins prior to allogeneic stem cell transplantation: results of a multicenter prospective phase 2 trial. Cancer 2014; 121: 562–569.

    Article  Google Scholar 

  11. Mohty M, Malard F, Savani BN . High-dose total body irradiation and myeloablative conditioning before allogeneic stem cell transplantation: time to rethink? Biol Blood Marrow Transplant 2014; 21: 620–624.

    Article  Google Scholar 

  12. Malard F, Chevallier P, Guillaume T, Delaunay J, Rialland F, Harousseau JL et al. Continuous reduced nonrelapse mortality after allogeneic hematopoietic stem cell transplantation: a single-institution's three decade experience. Biol Blood Marrow Transplant 2014; 20: 1217–1223.

    Article  Google Scholar 

Download references

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).

Author information

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

Authors
  1. M Mohty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Malard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Mohty.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2015.82

This article is cited by

Search

Advanced search

Quick links