The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia:: a donor vs no donor comparison

Using a genetic randomization through a ' donor' vs ' no donor' comparison, the aim of this analysis was to assess the real benefit of reduced intensity conditioning allogeneic stem cell transplantation ( RIC- allo- SCT) among 95 adult high- risk acute myeloid leukemia ( AML) patients. In an ' intention- to- treat' analysis, leukemia- free survival ( LFS) was significantly higher in the ' donor' group as compared to the ' no donor' group ( P = 0.01; 54 vs 30% at 4 years). The latter held true when restricting the analysis to the 25 patients who could actually receive the RIC- allo- SCT ( P = 0.001). Overall transplant- related mortality in the ' transplant' group was 12%, with overall survival ( OS) being significantly higher in the ' transplant' group as compared to the ' no transplant' group ( P = 0.01). Also, in the ' intention- to- treat' analysis, OS was significantly higher in the ' donor' group as compared to the ' no donor' group ( P = 0.04). In the multivariate analysis, actual performance of RIC- allo- SCT ( P = 0.001; RR = 4.0; 95% CI, 1.7 - 9.6) was the strongest factor significantly predictive of an improved LFS. We conclude that if a matched related donor is identified, RIC- allo- SCT should be proposed for AML patients not eligible for standard myeloablative allo- SCT.