Non-myeloablative versus reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia patients aged ≥65: a study from the ALWP of EBMT
Kanellopoulos, A Labopin, M Spyridonidis, A Nikolousis, E Platzbecker, U Blaise, D Sengeloev, H Kinsella, F Schroeder, T Choi, G
Kanellopoulos, A
Labopin, M
Spyridonidis, A
Nikolousis, E
Platzbecker, U
Blaise, D
Sengeloev, H
Kinsella, F
Schroeder, T
Choi, G
Abstract
The optimal conditioning intensity for allogeneic hematopoietic stem cell transplantation (allo-HCT) in elderly acute myeloid leukemia (AML) remains elusive. We retrospectively analyzed 2900 AML patients aged ≥65 in complete remission who underwent allo-HCT from 2004 to 2021. Conditioning was classified as reduced-intensity conditioning (RIC: fludarabine with busulfan, melphalan, or treosulfan) or non-myeloablative (NMA: fludarabine with total body irradiation). Primary endpoints were overall survival (OS) and leukemia-free survival (LFS); secondary endpoints included non-relapse mortality (NRM), acute and chronic graft-versus-host disease (GVHD), and GVHD/relapse-free survival (GRFS). With follow-up censored to account for differences between arms, OS, LFS, and NRM at 2 years were similar between RIC and NMA on multivariable analysis. Peripheral blood stem cells (PBSC) were independently associated with superior OS (HR 0.67, p = 0.002) and LFS (HR 0.71, p = 0.008) versus bone marrow grafts. GRFS was equivalent between conditioning intensities, although RIC was associated with higher acute GVHD and NMA with higher extensive chronic GVHD. In exploratory analysis, OS and LFS were similar across RIC regimens (Flu/Bu2 as reference: Flu/Mel OS HR 0.91, p = 0.53; Flu/Treo OS HR 0.89, p = 0.42). In older AML patients in remission, RIC and NMA yield comparable survival and NRM; PBSC grafts may be associated with superior outcomes although this warrants validation.
MIDER Authors
Affiliations
Sheffield Teaching Hospitals NHS Foundation Trust; Sorbonne University; Assistance Publique des Hopitaux de Paris; University of Patras; University Hospitals Birmingham NHS Foundation Trust; University Hospital Leipzig; Institut Paoli Calmettes; National University Hospital Copenhagen; Birmingham Centre for Cellular Therapy and Transplantation; University Hospital Essen; University Medical Center Groningen; Manchester University NHS Foundation Trust; University of Heidelberg; Medizinische Klinik u. Poliklinik V-Heidelberg; King’s College Hospital NHS Foundation Trust; University Medical Center Rotterdam; University Hospital Basel; Hannover Medical School; Aarhus University Hospital; Gustave Roussy Cancer Campus; University Hospital Maastricht; University of Muenster; Centre Hospitalier Universitaire Estaing; University of Nottingham; Centre Hospitalier Universitaire Lapeyronie; University of Sheffield; Vanderbilt University Medical Center; Ospedale San Raffaele; Chaim Sheba Medical Center
Date
2026-06-21
Type
Article
Collections
Citation
Kanellopoulos A, Labopin M, Spyridonidis A, Nikolousis E, Platzbecker U, Blaise D, Sengeloev H, Kinsella F, Schroeder T, Choi G, Tholouli E, Dreger P, Potter V, Socie G, Broers AEC, Passweg J, Eder M, Olesen G, Bourhis JH, Van Gorkom G, Stelljes M, Bay JO, Byrne JL, Ceballos P, Snowden JA, Savani BN, Brissot E, Ciceri F, Nagler A, Mohty M. Non-myeloablative versus reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia patients aged ≥65: a study from the ALWP of EBMT. Bone Marrow Transplant. 2026 Jun 21. doi: 10.1038/s41409-026-02935-9. Epub ahead of print.