Older patients with acute myeloblastic leukaemia do significantly benefit from reduced intensity conditioning (RIC) transplantation despite the increased risks with age, a large UK trial has found.

Building on work showing that an RIC allograft – particularly if from a sibling donor – improves survival in patients aged 35 to 65 years, researchers have now shown the benefit extends to older age groups.

In a study of 932 patients aged 60 to 70 years who had entered remission and did not have favourable risk AML but were considered fit enough to have intensive treatment, RIC showed significant survival benefit across subgroups.

Overall 144 RIC transplants were done, 52 from matched sibling donors and 92 from matched unrelated donors. Of the RIC group, 93 had intermediate risk cytogenetics, 18 adverse and 33 were unknown, the team reported in Haematologica.

In transplanted patients, survival was 37% at five years, a significant improvement over the 20% for those treated with chemotherapy.

The researchers from the National Cancer Research Institute ALM Working Group also showed that survival for sibling donors (44%) was better than that for unrelated donors (34%) but it was not found to be significant.

Consistent benefits were seen for RIC even when patients were stratified into good, standard and poor risk categories.

The benefit for RIC was seen in patients with a FLT3 ITD or NPM1 mutation with no evidence of a differential effect by genotype, they added.

Overall they concluded: “RIC transplant is an attractive option for older AML patients lacking favourable risk cytogenetics and in this study, we could not find a group that did not benefit.”

Speaking with the limbic, study leader Professor Nigel Russell, head of the Nottingham Haematology Group said: “With older age comes a greater procedural risk so the risks or treatment related mortality are higher in older patients but despite that there is a definite survival benefit.”

He added that patients would still need to be assessed for their fitness to undergo transplantation taking into account various parameters.

“One factor is age itself so few are done over 70. Secondly general fitness and comorbidity. However, more work is needed to define which genomic types of AML benefit from transplant and which may do better or as well without.”

The research team noted that more detailed genomic analysis may be particularly useful in intermediate risk patients where it has been reported that transplant benefit is limited to those with gene mutations typical of secondary AML.