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A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission.

Abstract
Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOL-adjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.
AuthorsSaiko Kurosawa, Takuhiro Yamaguchi, Shuichi Miyawaki, Naoyuki Uchida, Heiwa Kanamori, Kensuke Usuki, Takuya Yamashita, Masato Watanabe, Kazuaki Yakushiji, Shingo Yano, Yuichiro Nawa, Jun Taguchi, Jin Takeuchi, Junji Tomiyama, Yuko Nakamura, Ikuo Miura, Yoshinobu Kanda, Yoichi Takaue, Takahiro Fukuda
JournalBlood (Blood) Vol. 117 Issue 7 Pg. 2113-20 (Feb 17 2011) ISSN: 1528-0020 [Electronic] United States
PMID21106987 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antineoplastic Agents
Topics
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Antineoplastic Agents (therapeutic use)
  • Databases, Factual
  • Decision Support Techniques
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Kaplan-Meier Estimate
  • Leukemia, Myeloid, Acute (drug therapy, mortality, therapy)
  • Male
  • Markov Chains
  • Middle Aged
  • Quality of Life
  • Remission Induction
  • Retrospective Studies
  • Transplantation, Homologous
  • Young Adult

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