Bipin N. Savani

The optimal reduced-intensity conditioning (RIC) regimen for older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) undergoing allogeneic hematopoietic stem cell transplantation (AHCT) remains undefined. We utilized CIBMTR registry data (2013-2022) to compare five common fludarabine-based regimens in 11,731 patients aged ≥50 years: fludarabine combined with 2 days of busulfan (FB2), melphalan 100 mg/m² (FM100), melphalan 140 mg/m² (FM140), or 2 Gy TBI with (FCT) or without (FT) cyclophosphamide. Using propensity score inverse probability weighting and Bayesian Additive Regression Trees (BART), we found that Fludarabine-melphalan (FM) regimens demonstrated superior long-term survival. Although FM140, FCT, and FT showed higher early mortality (≤6 months) than FB2 (P=.036), both FM100 (HR 0.79) and FM140 (HR 0.77) achieved significantly better late (> 6 months) overall survival (OS), outperforming all other regimens (P<.0001). In the 2019-2022 cohort, FM100, FM140, and FCT provided improved disease-free survival (DFS) relative to FB2. Specifically, FM100 yielded superior DFS compared to FCT (P=0.002) and FT (P=0.007). FM-based conditioning consistently resulted in lower relapse rates (P<.0001) and improved late GVHD-free/relapse-free survival. While FM regimens faced higher early non-relapse mortality (NRM), this impact did not persist beyond 6 months. BART analysis confirmed that these survival and relapse benefits remained robust across various patient comorbidities. In conclusion, FM100 and FM140 provide superior long-term survival and DFS for older patients with AML/MDS by providing potent anti-leukemic activity that offsets higher early toxicity. These findings support FM-based RIC as the preferred conditioning platform for this population, regardless of baseline comorbidities.

Refusal of blood transfusion has historically been associated with members of the Jehovah’s Witness (JW) faith. As such, a range of transfusion-sparing strategies have been developed for these individuals and others who refuse standard blood transfusion. Techniques that maintain blood in continuous circuit with the patient are often acceptable and have been used in operative settings, including cell salvage and acute normovolemic hemodilution. By contrast, blood that has been collected and stored for later use has traditionally been considered unacceptable, which has limited the use of both allogeneic and autologous blood products. A March 2026 update by the governing body of Jehovah’s Witnesses, The Watch Tower Bible and Tract Society of Pennsylvania, moves decisions about the storage and reinfusion of a patient’s own blood into the realm of individual conscience, which may expand the use of autologous transfusion. Given this change, requests for autologous transfusion from JW patients may increase. In this letter, we offer practical guidance on balancing respect for patient autonomy and religious belief with the medical and logistical challenges of autologous blood transfusion.

From the 2026 National Summit on Hematologic Cancers

Allogeneic hematopoietic cell transplantation (allo-HCT) can cure acute leukemia, but relapse and non-relapse mortality restrict its success. Existing models focus on single prognostic areas and are not designed to predict leukemia-free survival (LFS), the outcome that best reflects allo-HCT’s curative intent. In this large retrospective cohort of allografted AL patients ( N = 24,317), we combined key pre-transplant patient, disease, and treatment factors into a practical holistic H-score to predict post–allo-HCT LFS. Component weights were derived from Cox-regression hazard ratios in a training cohort ( N = 19,029). The model was validated in a geographically split testing cohort (N = 4760), with outcomes assessed using Kaplan-Meier analysis and multivariate Cox models. In the overall cohort ( N = 24,317), 2-year overall survival and LFS were 64% and 56%, respectively. The H-score stratified patients into four risk groups, with 2-year LFS ranging from 66.2% in the low-risk group to 32.0% in the very high-risk group. The H-score was the strongest independent predictor of LFS ( p < 0.0001), outperforming individual indices and offering more refined risk stratification. The H-score was also an independent predictor of overall survival, relapse, and non-relapse mortality. While individual prediction is limited, the H-score aids patient counseling and provides a useful baseline for comparing new transplant treatments.

The optimal conditioning intensity for allogeneic hematopoietic stem cell transplantation (allo-HCT) in elderly acute myeloid leukemia (AML) remains elusive. We retrospectively analyzed 2900 AML patients aged ≥65 in complete remission who underwent allo-HCT from 2004 to 2021. Conditioning was classified as reduced-intensity conditioning (RIC: fludarabine with busulfan, melphalan, or treosulfan) or non-myeloablative (NMA: fludarabine with total body irradiation). Primary endpoints were overall survival (OS) and leukemia-free survival (LFS); secondary endpoints included non-relapse mortality (NRM), acute and chronic graft-versus-host disease (GVHD), and GVHD/relapse-free survival (GRFS). With follow-up censored to account for differences between arms, OS, LFS, and NRM at 2 years were similar between RIC and NMA on multivariable analysis. Peripheral blood stem cells (PBSC) were independently associated with superior OS (HR 0.67, p = 0.002) and LFS (HR 0.71, p = 0.008) versus bone marrow grafts. GRFS was equivalent between conditioning intensities, although RIC was associated with higher acute GVHD and NMA with higher extensive chronic GVHD. In exploratory analysis, OS and LFS were similar across RIC regimens (Flu/Bu2 as reference: Flu/Mel OS HR 0.91, p = 0.53; Flu/Treo OS HR 0.89, p = 0.42). In older AML patients in remission, RIC and NMA yield comparable survival and NRM; PBSC grafts may be associated with superior outcomes although this warrants validation.

The International Academy for Clinical Hematology (IACH) is a global, non-profit educational organization dedicated to advancing excellence, equity, and innovation in clinical hematology. Since its creation, the IACH has built an international community spanning more than 130 countries, leveraging digital-first education, scientific collaboration, and professional networking to improve patient care worldwide. This document presents the IACH Strategic Vision for 2026–2030, outlining a structured roadmap for the Academy’s next phase of growth and international leadership. The strategy is built upon six interdependent pillars: scientific excellence and credibility; digital leadership and intelligent learning; academic alliances and global footprint; innovation, visibility, and advocacy; transparency and sustainability; and brand positioning with global impact. By reinforcing scientific rigor, embracing digital transformation, and promoting innovation, the IACH aims to become the most trusted global reference for clinical hematology education and collaboration. This strategic vision positions the IACH as a unifying platform to unite the world hematology community under one banner of knowledge, collaboration, and compassion, for the benefit of every patient, everywhere.