Optimizing Reduced-Intensity Conditioning for Older Patients with AML and MDS: A Large-Scale Analysis from the CIBMTR.

In CIBMTR registry patients aged ≥50 with AML/MDS receiving allogeneic HCT, fludarabine–melphalan regimens (FM100, FM140) showed superior late overall survival versus fludarabine–busulfan (FB2), with HR 0.79 and 0.77.

• Why it matters: The best reduced-intensity conditioning choice for older AML/MDS patients remains unclear, limiting how clinicians balance early toxicity against longer-term survival and relapse control.
• What they did: Using 2013–2022 CIBMTR data (11,731 patients) comparing five fludarabine-based regimens, investigators applied propensity score inverse probability weighting and Bayesian Additive Regression Trees to estimate overall survival, disease-free survival, relapse, and GVHD outcomes.
• The result: FM100 and FM140 had higher early mortality (≤6 months) than FB2 for FM140, FCT, and FT (P=.036), but both FM100 (HR 0.79) and FM140 (HR 0.77) improved late (>6 months) overall survival (P<.0001), with lower relapse (P<.0001) and better late GVHD-free/relapse-free survival.

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