Maximum supportive care, standard conditioning and allogeneic stem cell transplantation for elderly patients with...

Dose-intense conditioning (DIC) (myeloablative) regimens for allogeneic stem cell transplantation (alloSCT) were previously avoided in patients with acute myelogenous leukemia aged more than 55 years because of the fear of excessive morbidity and mortality. The introduction of reduced-intensity conditioning (RIC) alloSCT led to their increasing use in these patients because of their reduced toxicity. Significant disadvantages remain, however, including the late establishment of a posttransplant graft-versus-leukemia effect and an overrepresentation of poor prognostic factors in elderly patients, resulting in the risk of early relapse/progression before the graft-versus-leukemia effect being disproportionally large. Preliminary results suggest that DIC with maximum prophylaxis and support is safe for elderly patients up to age 70 years. We hypothesize that DIC may be important for the early control of leukemia in elderly patients, and that prospective, randomized trials comparing DIC and RIC-based transplants should be carried out, with the expectation that early transplant-related mortality will be no different.