The goal of this analysis was to define the role of the moderate-intensity 
fludarabin Ara-C amsacrin (FLAMSA)-reduced intensity conditioning (RIC) regimen 
for patients with high-risk AML undergoing allogeneic SCT (alloSCT) in first 
CR1. High-risk was defined by (1) AML secondary to MDS or radio/chemotherapy, 
(2) unfavorable cytogenetics or (3) delayed response to induction chemotherapy. 
A total of 23 of 44 AML patients referred to the University of Munich for 
alloSCT in CR1 between 1999 and 2006 fulfilled these criteria and received 
FLAMSA chemotherapy, followed by RIC (4 Gy TBI/cyclophosphamide/ATG) for 
alloSCT. Twenty-two patients engrafted, one died in aplasia. Two-year cumulative 
incidences for relapse and nonrelapse mortality (NRM) were 4.6 and 22.5%, 
respectively. Four-year overall and leukemia-free survival was 72.7% (median 
follow-up among survivors: 35 months). The results of this high-risk cohort were 
compared to the outcome of 21 consecutive standard-risk patients <55 years, who 
had received standard, myeloablative sibling SCT in CR1 AML within the same 
center and time period. Survival and cumulative incidences of relapse and NRM 
were identical in both groups. In conclusion, the FLAMSA-RIC regimen produces 
long-term remission in a high proportion of patients with high-risk AML 
transplanted in CR1. In this cohort, FLAMSA-RIC showed equivalent antileukemic 
activity as compared to the standard protocols.