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Patients with MDS aged 18\u201365 years were randomized to receive MAC (<jats:italic>N<\/jats:italic>\u2009=\u200964) with busulfan\/cyclophosphamide or RIC (<jats:italic>n<\/jats:italic>\u2009=\u200965) with busulfan\/fludarabine followed by stem cell transplantation -(HCT) from HLA matched or mismatched donor. After a median follow-up of 6.2 (0.4\u201312.5) years, 10-year OS and RFS were 54.0% and 43.9% for RIC and 44.4% and 44.2% for MAC (<jats:italic>p<\/jats:italic>\u2009=\u20090.15 and <jats:italic>p<\/jats:italic>\u2009=\u20090.78), respectively. Since the first report, 6 patients died on NRM, 4 after RIC, and 2 after MAC. Similarly, 8 patients relapsed (4 in each arm), increasing the number of relapsed patients to 28. The second HCT was performed in 18 pts, 8 in the MAC, and 10 in the RIC arm. In a multivariate analysis, ECOG status and chemotherapy prior to HCT were independent risk factors for OS and RFS, ECOG and low cytogenetic risk for NRM and chemotherapy prior to HCT for RI. Patients with low cytogenetic risk had better OS [<jats:italic>p<\/jats:italic>\u2009=\u20090.002], RFS [<jats:italic>p<\/jats:italic>\u2009=\u20090.02], and NRM (<jats:italic>p<\/jats:italic>\u2009=\u20090.015) after RIC as compared to MAC.<\/jats:p>","DOI":"10.1038\/s41409-024-02282-7","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T17:02:30Z","timestamp":1714064550000},"page":"1084-1091","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Reduced intensity versus myeloablative conditioning for MDS: long-term results of an EBMT phase III study (RICMAC)"],"prefix":"10.1038","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0114-1011","authenticated-orcid":false,"given":"Christian","family":"Niederwieser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Iacobelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8239-002X","authenticated-orcid":false,"given":"Georg-Nikolaus","family":"Franke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Koster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"van Os","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-3239","authenticated-orcid":false,"given":"Uwe","family":"Platzbecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"H\u00fcbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Scheid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-8166","authenticated-orcid":false,"given":"Lutz Peter","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Stelljes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9605-485X","authenticated-orcid":false,"given":"Elena","family":"Morozova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7092-3351","authenticated-orcid":false,"given":"Jakob","family":"Passweg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Onida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7429-8570","authenticated-orcid":false,"given":"Peter","family":"Dreger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Saccardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ladetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urpu","family":"Salmenniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6052-2618","authenticated-orcid":false,"given":"Wolfgang","family":"Bethge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Poir\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Kobbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1224-091X","authenticated-orcid":false,"given":"Donal P.","family":"McLornan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-9876","authenticated-orcid":false,"given":"Marie","family":"Robin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2961-4183","authenticated-orcid":false,"given":"Nicolaus","family":"Kr\u00f6ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"2282_CR1","doi-asserted-by":"publisher","unstructured":"Ma X. 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NK received an honorarium from Novartis, Neovii, Riemser, and BMS. PD consultancy for AbbVie, AstraZeneca, Beigene, BMS, Gilead, Miltenyi, Novartis, Riemser; speakers\u2019 bureau for AbbVie, AstraZeneca, BeiGene, BMS, Gilead, Novartis, Riemser, Roche; research support from Riemser (all to institution). WB received Honoraries and Travel Grants from Medac, Miltenyi, BMS, Janssen, and Novartis. MR received research funding (independent studies) from AbbVie, Novartis, Medac, and Astex. LPM received an honorarium from Pfizer, Gilead Novartis, Amgen, Jazz, and Neovii.KH received research support from Celgene\/BMS, Gilead, Incyte, Janssen, Roche, and Sanofi and honorarium from AbbVie, EUSA Pharma, Gilead, Incyte, Novartis, Roche, Beigene, Celgene\/BMS, EUSA Pharma, Incyte, Roche, Sanofi. UP received honoraria from Abbvie, Celgene\/Jazz, Curis, Geron, and Janssen for consulting or advisory roles from BMS GmbH & Co KG, Celgene\/Jazz, and Novartis, research funding from Amgen, BerGenBio, Celgene, Curis, Janssen, and Novartis, and travel sponsoring, accommodations, and expenses from Celgene. DPM received honoraria\/consultation fees from Novartis, Jazz Pharma, and partial participation in a company-sponsored bureau (AbbVie, CTI).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}