Comparison of autologous hematopoietic cell transplantation and chemotherapy as postremission treatment in non-M3 acute myeloid leukemia in first complete remission.

Abstract

UNLABELLED:

Randomized trials of acute myeloid leukemia (AML) in first complete remission (CR1) showed that autologous hematopoietic cell transplantation (auto-HCT) improves relapse-free survival (RFS) but not overall survival (OS), compared with chemotherapy. Using a database of 2518 adult patients with AML in CR1, we conducted a 5-month landmark analysis and found that auto-HCT improves 3-year RFS but not OS compared with chemotherapy.

INTRODUCTION:

A number of randomized trials in patients with AML in CR1 have been conducted and they showed that auto-HCT improves RFS but not OS, compared with chemotherapy. However, because these trials have had compliance problems, the value of auto-HCT still has not been clearly established.

PATIENTS AND METHODS:

Using a database of 2518 adult patients with AML in CR1, we retrospectively analyzed the outcome of auto-HCT and compared it with intensive nonmyeloablative chemotherapy using landmark analyses.

RESULTS:

In 103 auto-HCT recipients, OS and RFS at 3 years from treatment were 65% and 57%, respectively. Multivariate analysis showed that unfavorable risk cytogenetics and entry into CR1 after 2 courses of induction treatment predicted a poor outcome. Because the median time interval between CR1 and auto-HCT was 153 days, landmark analyses at 5 months after CR1 were performed to compare 1290 patients who received chemotherapy alone (median age, 52 years; range, 16-70) with 103 who received auto-HCT (median age, 48 years; range, 16-67). Auto-HCT improves 3-year RFS (58% vs. 37%; P < .001) but not OS compared with chemotherapy alone. Among patients with unfavorable risk cytogenetics or those who required 2 courses to reach CR1, there was no significant difference in RFS between the 2 groups.

CONCLUSION:

Auto-HCT can be considered as a postremission therapy for AML patients with favorable or intermediate risk cytogenetics who achieve CR1 after a single course of induction treatment.

• Authors: Kensuke Usuki, Saiko Kurosawa, Naoyuki Uchida, Kazuaki Yakushiji, Fusako Waki, Eijo Matsuishi, Kumiko Kagawa, Tatsuo Furukawa, Yoshinobu Maeda, Manabu Shimoyama, Hiroatsu Ago, Yujiro Yamano, Shingo Yano, Naohito Fujishima, Yasushi Takamatsu, Tetsuya Eto, Michihiro Hidaka, Hitoshi Matsuoka, Takahiro Fukuda
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 12 Issue 6 Pg. 444-51 (Dec 2012) ISSN: 2152-2669 [Electronic] United States
• PMID: 22999942 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Disease-Free Survival
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Leukemia, Myeloid, Acute (drug therapy, genetics, surgery)
• Middle Aged
• Randomized Controlled Trials as Topic
• Remission Induction
• Retrospective Studies
• Transplantation, Autologous
• Treatment Outcome
• Young Adult