Dose intensity of preparative regimens for acute myeloid leukemia – One-size-fits-all or tailor-made?

Both toxicity and leukemia eradication correlate with the intensity of the transplant preparative regimen. How much any specific patient benefits from increased dose intensity depends, in part, on his/her ability to tolerate higher-dose therapy and the status of the leukemia being treated. Newer tools that include not only age and performance status, but also comorbidity indices, are useful for predicting the ability of a patient to tolerate therapy and should allow for the development of models predicting risk/benefit ratios for the use of more or less intense preparative regimens for any specific patient. If attempts are made to build such models, recent transplant data should be used, since advances in ancillary transplant measures (including better approaches to infection management and treatment of graft-vs-host disease) have led to improved transplant outcomes over the last decade. Ultimately, the goal should be to create preparative regimens with greater antileukemic intensity but with minimal extramedullary toxicity.