Decitabine + FLAG-Ida + TBI conditioning for high-risk myeloid malignancies

Current understanding

A phase I/II trial is testing whether adding the hypomethylating agent decitabine to a FLAG-Ida + total-body irradiation conditioning backbone improves outcomes versus FLAG-Ida + TBI alone prior to allo-HSCT in adults with high-risk AML, MDS, or CMML. This represents a third axis of conditioning intensification (HMA incorporation into intensive chemo + TBI) distinct from the FluBu+TBI radiation-intensification axis and from the thiotepa alkylator-intensification axis being tested in CMML.

Evidence log

• 2026-05-15 — Chemotherapy (Decitabine in Combination With FLAG-Ida) and Total-Body Irradiation Followed by Donor Stem Cell Transplant for the Treatment of Adults With Myeloid Malignancies at High Risk of Relapse: cross-connection with thiotepa-busulfan-fludarabine-conditioning-cmml: Both trials enroll CMML and test conditioning intensification, but along different axes (HMA + intensive chemo + TBI vs. alkylator addition to FluBu); together they frame the open question of how best to intensify conditioning for high-risk myeloid disease. (novelty: 3)

Open questions

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