J Clin Oncol: Intensive conditioning solutions do not improve the prognostic prognostics of allo-HSCT in older patients with high-risk AML/MDS

The intensity-reducing regulation (RIC) program allows older patients with high-risk acute myeloid leukemia (AML) and myeloid growth abnormal syndrome (MDS) to receive allogeneic hematopoietic stem cell transplants with hematopoietic potential, but this is associated with a high risk of recurrence of the disease in such patients.
there is an urgent need for treatment strategies to reduce the risk of recurrence.
Available data suggest that the prognostics can be improved using a sequential transplantation, fluorodalabin/ammonia theanline/agarose-busulphan (FLAMSA-Bu) programme, but no randomized trials have been conducted to assess the effects of this enhanced regulatory programme on patient prognostics.
the study recruited 244 patients with high-risk AML (n-164) or MDS (n-80) and randomly assigned 1:1 to the Fluordarabin-based RIC program (control) group or flamsA-Bu group.
can monitor pre-transplantable residual lesions (MRD) by fluid cytometics and associate them with prognosis analysis.
2-year total survival or cumulative recurrence rate (CIR) in the control group and the FLAMSA-Bu group (risk ratio of 1.05 and 0.94, respectively).
tested pre-transplant MRD was associated with an increase in CIR (41.0% vs 20.0%) throughout the trial queue.
there is no evidence that MRD status is related to the strength of the conditioning scheme.
complete supply T-cell chimline at 3 months can eliminate the adverse effects of mrD state on CIR and total survival prognostication before transplantation.
overall, the enhanced RIC conditioning program, FLAMSA-Bu, does not improve the prognostication of high-risk AML or MDS elderly patients receiving transplant treatment, regardless of THED status prior to transplantation.
。