Impact of intensity of conditioning therapy in patients aged 40–60 years with AML/myelodysplastic syndrome undergoing allogeneic transplantation

The optimum intensity of conditioning therapy in patients aged 40–60 years with AML and myelodysplastic syndrome (MDS) undergoing allogeneic haematopoietic cell transplantation (alloHCT) remains uncertain. We compared outcomes of reduced intensity conditioning (RIC) and conventional intensity conditioning (CIC) in 101consecutive patients (CIC, 62; RIC, 39) with AML and MDS aged 40–60 years undergoing alloHCT from 2002 to 2008 at our centre. The median age, unrelated transplants and co-morbidity index were higher in the RIC group. Median OS and EFS were 31.0 months (95% confidence interval (CI): 12.8–59.3) and 20.7 months (95% CI: 11.0–30.4), respectively, with no significant difference between the two cohorts. The 3-year treatment-related mortality (TRM) and relapse were 28% (95% CI: 21–39) and 25% (95% CI: 17–36), respectively, with no significant difference between the two cohorts. No difference in OS, EFS, TRM or relapse was observed between the two cohorts in the multivariate model. Only disease risk was significantly associated with OS (Hazard ratio (HR): 1.85, CI: 1.01–3.45), EFS (HR: 1.73, 95% CI: 1.00–3.10) and cumulative relapse (HR: 3.24, 95% CI: 1.08–10.12). Disease biology rather than intensity of conditioning regimen seems to determine outcomes of alloHCT in patients aged 40–60 years with AML/MDS.