***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: When patients with acute myeloid leukemia ( AML ) relapse , prognosis is considered dismal , even if the patient experiences a long period of complete remission ( CR ) . Although we live in an era of genomic and epigenomic information , the management of elderly Korean patients with AML remains a challenge , given the patient 's age , poor performance status , and various pre-existing comorbidities . As we know , the incidence of AML increases sharply with age , especially after the age of 55 . According to the Surveillance , Epidemiology , and End Results ( SEER ) data ( 2006 - 2010 ) , almost 70 % of AML patients are > 55 years old , with the peak incidence occurring at > 75 years [ 1 , 2 , 3 ] . Unfortunately , most elderly AML patients do not receive intensive therapies , due to their age , a pattern that is based on the common misconception that elderly patients can not tolerate chemotherapies . US SEER data from 2000 - 2007 revealed that only one third of elderly AML patients received early chemotherapy after initial diagnosis [ 2 ] , although no Korean data exists to date . However , higher comorbidities and poor performance status , have a greater negative impact than age per se . Although there have been no large efficacy trials for these patients , large registry data , in addition to some positive retrospective studies , have shown that intensive induction therapy can improve survival [ 4 , 5 , 6 ] . There are currently many ongoing trials for selected elderly AML patients , including some with post-CR allogeneic hematopoietic stem cell transplantation ( alloHSCT ) approaches . However , a well design ed treatment for elderly AML patients should be examined prospect ively to determine whether patients who receive less toxic therapies achieve CR , whether post-CR alloHSCT may be avoided , and whether a true cure can be found with recent novel therapeutic agents . In the present issue of Blood Research , Yi et al. [ 7 ] found that carefully selected elderly Korean AML patients ( median age 70 years ) experienced beneficial effects after treatment with either high-intensity regimens ( HIR ) or low-intensity regimens ( LIR ) . The authors found that the median survival periods with HIR and LIR  were 6.8 and 10.2 months , respectively , compared to just 1.6 months for patients who only received supportive care ( SC ) . Multivariate analysis of the 168 patients , diagnosed in five institutes , identified age , ECOG performance status , Hb level , and serum creatinine at diagnosis as statistically significant prognostic factors for survival . Given the low sample numbers in the study , the authors suggested that further prospect i ve trials would be necessary to identify specific prognostic factors , which could be used to precisely characterize elderly Korean AML patients . However , some limitations in the study , and particularly some novel aspects that are presented should be noted . Firstly , the conclusion that HIR ( N=76 ) provides an inferior median survival to LIR ( N=18 ) ( 6.8 months vs. 10.2 months ) is based on a very small sample size , and may not be supported by the study results . The CR rate in the LIR group was just 5.6 % , compared to 42.9 % in the HIR group , which may suggest that the LIR group had been drawn from antiquated trials of uncertain design . Although LIR may contain various dose-intensity schedules , the overall median survival of 10.2 months for AML patients > 65 years old is not a disappointing result , especially when compared with many older studies , or even recent therapeutic trials with novel agents [ 8 ] . Therefore , this date d treatment method should be amended , so as not to create confusion in a field clouded by lack of consensus . The authors also state that CR rates in the favorable , intermediate , and unfavorable groups were 20.0 % , 22.6 % , and 21.8 % respectively . However , it is useless to comment on the risk grouping in this study , if the categorization was solely dependent on conventional cytogenetics , without molecular parameters . Although elderly AML patients receiving only SC ( N=66 ) had a survival of 1.6 months , there was a prolonged survival for patients who received either HIR or LIR . However , these patients did not receive further intensive stem cell transplantation after achieving CR , since the extremely elderly patient ( > 65 years ) were considered unable to maintain continuous CR and were unable to obtain reimbursement for alloHSCT in Korea . Secondly , the 168 patients diagnosed at Gyeonggi area hospitals did not accurately represent elderly Korean patients with AML . As well , the four parameters from the analytic prognostic factors in this study do not accurately represent Korean patients either . Lastly , the continuous improvements of treatment regimens , through the introduction of epigenetic modulators in the 21st century , along with post-CR alloHSCT with reduced toxicity conditioning , should have been investigated , since even patients aged 65 - 75 years have exhibited encouraging results . Instead of the multivariate analyses performed on all patients , or on the HIR , I recommend other productive conclusions after examining the data . The study included only 168 patients , diagnosed at local Korean institutes , where there are simply too many confounding variables to be considered in each facility . However , recent therapeutic reports for elderly Korean AML patients note that regimens containing low-dose cytosine arabinoside or mylotarg had similar superior outcomes , when compared to conventional intensive care patients [ 9 , 10 ] . These results are especially notable for low-risk groups after considering multiple parameters , including comorbidity score , ECOG performance status , and age . Similarly , Yi et al. [ 7 ] found that age , ECOG performance status , Hb level , creatinine level , and C-reactive protein ( CRP ) level at initial diagnosis were considered prognostic factors . Although their study , as a pilot retrospective investigation , contains weaknesses , further prospect i ve studies with well-selected patients could result in much improved outcomes for elderly Korean AML patients . I suggest that reliable prognostic and /or predictive factors should be used for approaching intensive therapies , including the use of elective alloHSCT after CR . Although age has been considered one of the most important risk factors in most historical studies , tailor-made therapies , based on well- design ed clinical trials with quality of life considerations , should be used to define the appropriate multimodality for current therapeutic options . The concept that AML patients older than 65 or 70 years can not achieve CR should be rejected , since some patients possess favorable molecular cytogenetic profiles , allowing them to maintain continuous CR through treatment with only low-dose cytosine arabinoside or hypomethylating agents in outpatient clinic . We are still faced with the unresolved old-age AML management hurdles , especially for true elderly patients aged over 70 - 75 years . Therefore , it is imperative that we develop more reasonable treatment strategies for aging Korean AML patients in the near future . Again , how old is old This prospect i ve trial assessed the safety and efficacy of allogeneic hematopoietic stem cell transplantation from a HLA‐matched donor with a reduced‐intensity regimen ( RIST ) consisting of iv fludarabine 30 mg/m2 for 6 days and oral busulfan 4 mg/kg/day for 2 days in patients older than 50 years with hematological malignancies .  Cyclosporine alone or cyclosporine with short‐term methotrexate was r and omized for graft‐versus‐host disease prophylaxis . After 30 patients had been enrolled , an interim analysis was performed , and this report focuses on a precise evaluation of the toxicity profile and chimerism kinetics . Sustained engraftment in all patients , no severe regimen‐related toxicity ( RRT ) within 20 days , and no transplant‐related mortality through Day 100 were observed . T‐cell ( CD3 + ) full‐donor ( over 90 % ) chimerism was observed in 22 of the 30 patients , while the remaining eight had mixed‐donor chimerism over 77 % on Day 90 . Thereafter , five subsequently converted to full‐donor chimerism without donor lymphocyte infusion by day 120 ( n = 4 ) or Day 180 ( n = 1 ) . Two showed persistent mixed chimerism without relapse through Day 180 . Grade III – IV acute graft‐versus‐host disease and extensive chronic graft‐versus‐host disease occurred in 10 % and 73 % , respectively . With a median follow‐up of 1.5 years , overall survival and disease‐free survival at 1 year was 83 % and 62 % , respectively . Seven patients hematologically relapsed overall , and five of them had myelodysplastic syndrome with poor prognostic factors . In older patients , RIST with fludarabine and busulfan was associated with acceptable toxicities and a satisfactory antileukemia effect , regardless of the early chimerism status . Am . J. Hematol . 82:873–880 , 2007 . © 2007 Wiley‐Liss , The objective of this study was to assess toxicity and feasibility of achieving engraftment of allogeneic blood progenitor cells following nonmyeloablative conditioning according to the FCIE protocol ( fludarabine 25 mg/m2/day , days −7 to −3 ; cyclophosphamide 200 mg/m2/day , days −7 to −3 ; idarubicin 12 mg/m2/day , days −7 to −5 ; etoposide 250 mg/m2/day , days −4 to −3 ) in elderly patients with leukemia . Eleven patients were included in the study : six patients with acute myeloid leukemia ( AML ) in complete remission ( CR ) ; three patients with refractory or relapsed AML ; one patient with chronic myeloid leukemia ; one patient with acute lymphoblastic leukemia . The median age of the patients was 62 years . All patients received blood progenitor cells from an HLA-identical sibling with 8.8 × 106 CD34 + cells/kg ( median ; range 4.7 to 26.2 × 106/kg ) and 5.5 × 108 CD3+cells/kg ( median ; range 4.5 to 7.9 × 108/kg ) . Graft-versus-host disease ( GVHD ) prophylaxis consisted of cyclosporine and three courses of methotrexate . The median duration of white blood cell counts < 1 × 109/l was 17 days and of platelet counts < 50 × 109/l 20 days . In two patients acute GVHD grade I occurred . Nine of 10 patients analyzed developed mixed chimerism . Of seven patients transplanted in CR , three remained in CR 19 to 31 months after transplantation . Three patients with refractory leukemia did not achieve CR , while the patient with relapsed AML achieved a 3rd CR . After a median follow-up time of 22 months , chronic GVHD was mild and limited . The data from this pilot study in elderly patients with leukemia show that the combination of primarily immunosuppressive ( FC ) and antileukemic ( IE ) drugs for nonmyeloablative conditioning has moderate nonhematological toxicity and allows engraftment of allogeneic blood progenitor cells Summary : The purpose of this study was to evaluate the feasibility and efficacy of allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen ( RIST ) in patients with acute myeloid leukemia ( AML ) or myelodysplastic syndrome ( MDS ) . In all , 36 patients ( median age 55 years ) underwent RIST from an HLA-matched related donor between September 1999 and December 2002 . The diagnoses included AML ( n=14 ) , leukemia evolving from MDS ( n=10 ) , and MDS ( refractory anemia with excess blasts n=6 , refractory anemia n=6 ) . The RIST regimen consisted of purine analog ( cladribine or fludarabine)/busulfan , with or without antithymocyte globulin . The regimen was well tolerated , and 34 patients achieved durable engraftment and most achieved remission after RIST . A total of 17 patients developed grade II – IV acute GVHD , and 27 developed chronic GVHD . Eight patients relapsed , and five of them received  antithymocyte globulin  ( ATG ) as part of the preparative regimen . A total of 12 patients died ( four disease progression , six transplantation-related complications , and two others ) . Estimated 1-year disease-free survival ( DFS ) in low- and high-risk groups was 85 and 64 % , respectively . We conclude that RIST can be performed safely in elderly patients with myeloid malignancies , and has therapeutic potential for those who fail conventional chemotherapy . In view of the significant association between GVHD or ATG and DFS , defined management of GVHD following RIST should become a major target of clinical research Introduction . The incidence of Acute Myeloid Leukemia ( AML ) increases progressively with age and its treatment is challenging . This prospect i ve case control study was undertaken to compare the safety , efficacy , and cost-effectiveness of decitabine with those of cytarabine in older patients with newly diagnosed AML who are not fit for intensive chemotherapy . Material s and Methods . 30 eligible patients above 60 years old with newly diagnosed AML were assigned to receive decitabine or cytarabine . The primary end point was overall survival ( OS ) . The secondary objective was to compare adverse events and cost-effectiveness of therapy in the two study groups . Results . In this study , 15 patients received decitabine and 15 patients received cytarabine . The median OS was 5.5 months for each of the treatment groups 
    Output:
    
Conclusions RIC-alloHSCT is a feasible treatment option for the patients older than 50 year of age with MDS and AML .
Advanced diseases status and higher diseases risk may be the poor factors for prognosis