7031 Background: Absence of MRD in first complete remission (CR1) of AML decreases the probability of subsequent relapse both in patients given more (e.g. 7+3 or FLAG) or less (e.g. azacitidine) intense induction. Although high-intensity induction seems to increase the chance of CR without MRD, it is unknown whether induction intensity affects outcomes beyond eradication of MRD. Methods: We retrospectively studied adults with newly diagnosed AML or MDS with 10-20% blasts who received induction at the University of Washington from 2008 through 2015. Induction was classified as high or low intensity, CR defined by standard criteria, and marrow MRD by presence of blasts on multiparameter flow cytometry within 1-2 weeks of CR. Post-remission therapy in 10 patients included allogeneic hematopoietic cell transplant (HCT). Multivariate regression analysis examined the independent effects of age, initial cytogenetics (favorable, intermediate, adverse), performance status, de novo vs secondary AML, induction intensity, and MRD on post-CR outcomes. Results: 217 patients received high- and 38 low-intensity induction. 75% of the former vs. 42% of the latter achieved CR without MRD. Although high-intensity therapy was associated with longer overall survival (OS), this difference disappeared after accounting for the above covariates (HR 0.94, 95% CI 0.58 1.52, P = 0.8) and OS was poor regardless of chemotherapy intensity if MRD was present. Multivariate analysis found no interaction between the presence or absence of MRD and induction intensity (HR 0.95, 95% CI 0.4 2.29, P = 0.9). Conclusions: Receiving high-intensity induction chemotherapy does not appear to confer a separate advantage in long-term outcomes once CR without MRD is achieved, at least in patients mostly not receiving HCT. We are currently including more such patients who received HCT. Our results suggest that any effect of high-intensity induction largely reflects its association with a higher probability of achieving an MRD-negative CR.