Impact of conditioning regimen on outcomes of young AML patients ( < 40 years) undergoing HCT in complete remission, with transplant conditioning intensity score of 3.5-4.0. A study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation.
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The optimal myeloablative conditioning regimen for adolescents and young adults with acute myeloid leukaemia (AML) is currently unknown. In this retrospective analysis conducted on AML patients aged 18-40 years, in complete remission (CR), who received an allogeneic hematopoietic cell transplantation (HCT) we compared outcomes of different conditioning regimens. A total of 4323 patients, with median age of 30.9 years, transplanted from 2010 to 2022, received one of four regimens: high-dose total body irradiation (TBI)-based (n = 1031), thiotepa-busulfan (Bu)-fludarabine (Flu) (TBF) n = 219, Bu-Flu (n = 1100), and Bu-cyclophosphamide (Cy) (n = 1973). Prolonged OS and PFS for Bu-Flu (hazard ratio [HR] 0.73, 95% CI 0.57-0.92, p = 0.008; HR 0.78, 95% CI 0.64-0.94, p = 0.01), and TBF (HR 0.59, 95% CI 0.38-0.92, p = 0.02; HR 0.67, 95% CI 0.47-0.94, p = 0.02), respectively, as well as less RI for both Bu-Flu (HR 0.77, 95% CI 0.63-0.95, p = 0.01), and TBF (HR 0.68, 95% CI 0.47-0.99, p = 0.046). In conclusion, young adult AML patients seem to benefit from high dose TBI-free regimens, in terms of survival and toxicity, with four major myeloablative regimens. TBF and Bu-Flu were associated with better clinical outcomes, partly reflecting the general improvement in supportive therapies and patient selection introduced in recent years. Prospective clinical trials are warranted.