Science Highlights
Published on August 12, 2025
Fludarabine dose impact on allo-HSCT outcome for older adults with AML
by Nature
Dachy G, Labopin M, Socié G, et al. Impact of Fludarabine Dose on Outcome After Allo-HSCT with Reduced Intensity Conditioning for Older Patients with AML. Bone Marrow Transplantation. 2025; (doi: 10.1038/s41409-025-02614-1).
Older adults preparing for allogeneic hematopoietic stem cell transplantation (allo-HSCT) may benefit from lower doses of fludarabine during reduced-intensity conditioning (RIC), researchers say. Their retrospective study included 1,907 patients who underwent allo-HSCT between 2010 and 2022. Based on multivariate analysis, a dose of 110-130 mg/m2 of fludarabine during RIC was associated with better post-transplant outcomes than was seen with doses of 140-150 mg/m2, 151-160 mg/m2, or 170-190 mg/m2. Significantly improved leukemia-free survival (HR 1.46, 95% CI: 1.09–1.94) and graft-versus-host-free/relapse-free survival (HR 1.50, 95% CI: 1.12–1.99) were observed in the low-dose fludarabine recipients. The findings specifically apply to patients aged older than 50 years with acute myeloid leukemia without chronic kidney disease, who underwent allo-HSCT while in first complete remission of their disease. Additional work is needed, the study authors concur, to confirm and build on these results — especially in the context of different patient populations and malignancies.
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