Trial shows skipping chemotherapy before transplant doesn’t reduce leukemia survival.
A major study known as ASAP is changing how doctors think about treating a type of blood cancer called acute myeloid leukemia, or AML. The project, led by the nonprofit organization DKMS, explored whether patients who need stem cell transplants might do just as well if they go straight to transplantation instead of going through another round of intense chemotherapy first.
For many years, the standard approach for patients whose leukemia returned or did not respond to treatment was to use aggressive chemotherapy to shrink the cancer before transplantation. The goal was to place the disease in remission before introducing new stem cells. The ASAP trial—short for “as soon as possible”—tested whether skipping that step could save time and reduce the risks of additional chemotherapy without harming long-term outcomes.
Researchers followed more than 500 patients with AML who were preparing for allogeneic stem cell transplantation, meaning they would receive stem cells from a donor. One group received the traditional path of intensive chemotherapy before transplantation, while another group underwent transplant sooner, after less aggressive treatment and careful monitoring. After more than five years of follow-up, both groups had nearly identical survival rates.
The findings showed that those who proceeded directly to transplantation had a five-year survival rate of 46.1%, while those who first went through chemotherapy had a rate of 47.5%. Although the numbers were close, the faster-transplant group spent about a month less in the hospital and had fewer complications from treatment. This suggested that patients with resistant or relapsed AML might not need to endure the physical and emotional toll of repeated rounds of chemotherapy before moving forward with transplantation.
Dr. Johannes Schetelig, one of the lead investigators, explained that these results challenge a long-standing belief in leukemia treatment—that patients must always achieve remission before transplant. The data showed that what matters more is the biology of the disease itself. Factors like age and genetic makeup had a much greater impact on survival than whether remission was reached beforehand.
Patients with favorable or intermediate genetic profiles lived longer, regardless of which treatment approach they received. Those with adverse genetic risk still faced lower survival odds, pointing to the need for more targeted strategies for that group. The study also supported earlier findings that genetic risk plays a stronger role in transplant success than pre-transplant chemotherapy intensity.
Experts see these results as a move toward more individualized care. Instead of following a one-size-fits-all model, doctors may soon tailor treatment plans based on genetic and biological details of each patient’s leukemia.
The ASAP trial is part of DKMS’s broader effort to improve blood cancer outcomes worldwide. As a nonprofit organization, DKMS funds studies and clinical trials that expand access to transplantation and explore new scientific directions not tied to commercial interests. Its research grants support both established scientists and emerging researchers focused on curing blood cancer.
By questioning long-held treatment traditions and supporting global collaboration, DKMS is helping shape a new chapter in leukemia care—one that gives patients faster access to potentially life-saving treatment while deepening understanding of how disease biology drives recovery.
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DKMS advances blood cancer research with groundbreaking ASAP study
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