Disease risk but not remission status determines transplant outcomes in AML: long-term outcomes of the ASAP trial.

However, benefit of remission induction strategy (RIST) before alloHCT has never been proven in a prospective trial. Potent conditioning regimens exist that allow for successful alloHCT in patients with active AML.

然而，在alloHCT之前进行缓解诱导策略（RIST）的好处从未在前瞻性试验中得到证实。存在有效的预处理方案，使得活跃的AML患者也能成功进行alloHCT。

Therefore, the ASAP trial was conducted to test RIST by salvage chemotherapy before alloHCT against immediate transplant after intensified conditioning.

因此，ASAP试验旨在通过在异基因造血干细胞移植（alloHCT）前进行挽救性化疗来测试RIST，与在强化预处理后立即进行移植进行比较。

In total, 281 patients with AML with poor response after first induction or untreated first relapse were randomized 1:1 to RIST with high-dose cytarabine plus mitoxantrone vs immediate alloHCT with sequential conditioning after nonintensive disease control (DisC) measures, preferentially watchful waiting only.

共有281名急性髓细胞性白血病（AML）患者在首次诱导治疗后反应不良或未治疗的首次复发后，按1:1的比例随机分为两组，一组接受以大剂量阿糖胞苷加米托蒽醌为主的RIST治疗，另一组则在非强化疾病控制（DisC）措施后，优先选择观察等待，随后进行序贯性预处理的立即alloHCT治疗。

Overall survivalat 5 years from randomization analyzed according to intention-to-treatwas 46.1% for DisC vs 47.5% for RIST (P = .82).

随机分组后5年的总生存率，按意向治疗分析，DisC组为46.1%，RIST组为47.5%（P = .82）。

In multivariable Cox regression analysis, genetic AML risk according to European LeukemiaNet criteria (P < .0001), age (P = .001), and comorbidities (P = .046) predicted survival, but not treatment arm (hazard ratio, 1.08 for DisC vs RIST; P = .67).

在多变量Cox回归分析中，根据欧洲白血病网络标准的遗传性AML风险（P < .0001）、年龄（P = .001）和合并症（P = .046）预测了生存率，但治疗组并未预测（危险比，DisC对RIST为1.08；P = .67）。

In conclusion, long-term follow-up of the ASAP trial showed no survival advantage for standard salvage chemotherapy before alloHCT as opposed to immediate alloHCT.

总之，ASAP试验的长期随访结果表明，在异基因造血干细胞移植（alloHCT）之前进行标准挽救化疗，并没有比立即进行alloHCT有更好的生存优势。

The trial results question the general concept of RIST with intensive standard salvage therapy before alloHCT for all patients, because immediate alloHCT may reduce time in hospital and health care expenses.

该试验结果质疑了在所有患者中，在异基因造血干细胞移植（alloHCT）之前进行强化标准挽救治疗（RIST）的普遍概念，因为立即进行alloHCT可能会减少住院时间和医疗费用。

Novel bridging therapies that are well tolerated, and posttransplant maintenance with targeted drugs are urgently warranted, especially for adverse-risk AML, to improve outcomes after alloHCT.

迫切需要开发耐受性良好的新型桥接疗法，并在异基因造血干细胞移植（alloHCT）后使用靶向药物进行维持治疗，特别是对于高危急性髓细胞性白血病（AML），以改善移植后的治疗结果。

This trial was registered at www.ClinicalTrials.gov as #NCT02461537.

该试验已在www.ClinicalTrials.gov上注册，注册号为#NCT02461537。