Allogeneic HCT Using Nonmyeloablative Host Conditioning With TLI & ATG vs SOC in AML

Exclusion Criteria

• •AML with favorable cytogenetic features based on SWOG Cytogenetic Criteria
• •AML, either treatment-related or MDS-related
• •Active CNS disease as identified by positive CSF cytospin at time of enrollment.
• •Prior or concurrent malignancies except localized non-melanoma skin malignancies or treated cervical carcinoma in situ. (EXCEPTION: Cancer treated with curative intent \> 5 years previously is allowed. EXCEPTION: Low grade lymphoma is allowed as long as active treatment is not required for control of disease)
• •Planned for allogeneic transplant using a full-dose conditioning
• •Life expectancy \< 1 year due to diseases other than malignancy
• •Pregnant or breastfeeding.
• •HIV-seropositive.
• •Uncontrolled infection (presumed or documented) with progression after appropriate therapy for greater than one month.
• •Symptomatic coronary artery disease or uncontrolled congestive heart failure. Left ventricular ejection fraction (LVEF) is not required to be measured, however if measured, exclusion if ejection fraction is \< 30%.
• •Requiring supplementary continuous oxygen. Diffusing capacity of the lungs for carbon monoxide (DLCO) is not required to be measured, however if it is measured, exclusion if DLCO \< 35%.
• •Fulminant liver failure
• •Cirrhosis with evidence of portal hypertension or bridging fibrosis
• •Alcoholic hepatitis
• •Esophageal varices
• •A history of bleeding esophageal varices
• •Hepatic encephalopathy
• •Uncorrectable hepatic synthetic dysfunction evidenced by prolongation of the prothrombin time
• •Ascites related to portal hypertension
• •Chronic viral hepatitis with total serum bilirubin \> 3 mg/dL
• •Symptomatic biliary disease