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Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission.

Abstract
The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P = .16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P = .15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P = .80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.
AuthorsErica D Warlick, Kristjan Paulson, Ruta Brazauskas, Xiaobo Zhong, Alan M Miller, Bruce M Camitta, Biju George, Bipin N Savani, Celalettin Ustun, David I Marks, Edmund K Waller, Frédéric Baron, César O Freytes, Gérard Socie, Gorgun Akpek, Harry C Schouten, Hillard M Lazarus, Edwin M Horwitz, John Koreth, Jean-Yves Cahn, Martin Bornhauser, Matthew Seftel, Mitchell S Cairo, Mary J Laughlin, Mitchell Sabloff, Olle Ringdén, Robert Peter Gale, Rammurti T Kamble, Ravi Vij, Usama Gergis, Vikram Mathews, Wael Saber, Yi-Bin Chen, Jane L Liesveld, Corey S Cutler, Armin Ghobadi, Geoffrey L Uy, Mary Eapen, Daniel J Weisdorf, Mark R Litzow
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 20 Issue 2 Pg. 202-8 (Feb 2014) ISSN: 1523-6536 [Electronic] United States
PMID24184335 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
CopyrightCopyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Topics
  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Hematopoietic Stem Cell Transplantation (methods, mortality)
  • Humans
  • Leukemia, Myeloid, Acute (therapy)
  • Male
  • Middle Aged
  • Remission Induction
  • Risk Factors
  • Survival Analysis
  • Transplantation Conditioning (methods, mortality)
  • Transplantation, Homologous (methods, mortality)
  • Young Adult

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