Early Hematopoietic Cell Transplantation Results in Higher Overall Survival and Leukemia Free Survival Compared to Conventional Chemotherapy in High Risk Acute Myeloid Leukemia (AML) Patients
Between 1996 and 2004, a total of 708 patients were enrolled in the AML ´96 and 2002 studies of the East German Study Group. Of those, 138 patients (19.5%) had unfavourable cytogenetics defined as complex karyotype, del (5q)/-5, del (7q)/-7, abn (3q26) and abn (11q23). Seventy-seven (56%) patients achieved CR1 after induction chemotherapy and were eligible for HCT. HCT was performed after a median of two cycles of consolidation chemotherapies in the AML ´96 and one cycle in the AML 2002 (p=0.03). After a median follow up of 21 months, OS amounted 73±14%, 50±14% and 14±8% at 3 years for patients after related HCT, unrelated HCT and chemotherapy, respectively (p=.008). Differences in outcomes were mainly due to a lower relapse incidence (26±13% for related and 48±15% for unrelated HCT) in patients after HCT compared to a higher relapse incidence in patients undergoing consolidation chemotherapy (89±8%; p=.003). Treatment-related mortality was low and not statistically significantly different between the three treatment groups (10±9%, 14±10% and 6± 6% for related, unrelated and chemotherapy; p=0.98). We conclude that early HCT from related or unrelated donors led to significantly better OS and LFS compared to chemotherapy in patients with unfavourable karyo type.
Cornelissen JJ, Putten WLJ, Verdonck LF, M T, Jacky E, Daenen SMG, et al. Results of a HO VON/SAKK donor versus no-donor analysis of myelo ablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: benefits for whom? Blood. 2007;109:3658–66.
2.
Basara N, Schulze A, U W. Early related or unrelated haematopoietic cell transplantation results in higher overall survival and leukaemia-free sutvival compared with conventional chemotherapy in high-risk acute myeloid leukaemia patients in first complete re mission. Leukemia. 2009;23:635–40.
3.
Slovak ML, Kopecky KJ, Cassileth PA, Harrington DH, Theil KS, Mohamed A, et al. Karyotypic analysis pre dicts outcome of preremission and postremission the rapy in adult acute myeloid leukemia: a Southwest Oncology Group/Eastern Cooperative Oncology Group study. Blood. 2000;96(13):4075–83.
4.
Milligan DW, Wheatley K, Littlewood T, Craig JI, AK B. Fludarabine and cytosine are less effective than standard ADE chemotherapy in high-risk acute myeloid leukemia, and addition of G-CSF and ATRA are not beneficial: results of the MRC AML-HR rando mized trial. Blood. 2006;107(12):4614–22.
5.
Yakoub-Agha I, Mesnil F, Kuentz M, Boiron JM, Ifrah N, Milpied N, et al. Allogeneic marrow stem-cell tran splantation from human leukocyte antigen-identical siblings versus human leukocyte antigen-allelic-mat ched unrelated donors (10/10) in patients with stan dard-risk hematologic malignancy: a prospective stu dy from the French Society of Bone Marrow Tran splantation and Cell Therapy. J Clin Oncol. 2006;24:5695–702.
6.
Chen AR, Alonzo TA, Woods WG, Arceci RJ. Current controversies: which patients with acute myeloid leukaemia should receive a bone marrow transplantati on?--an American view. Br J Harmatol. 2002;118:378–84.
7.
Creutzig U, Reinhardt D. Current controversies: which patients with acute myeloid leukaemia should receive a bone marrow transplantation?--a European view. Br J Harmatol. 2002;118:365–77.
8.
Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. In: Consensus Conference on Acute GVHD Grading Bone Marrow Transplant. 1994.
9.
Sullivan KM, Agura E, Anasetti C, Appelbaum F, C B, Bearman S, et al. Chronic graft-versus-host di sease and other late complications of bone marrow transplantation. Semin Hematol. 1991;28:250–9.
10.
Petersdorf EW, Gooley T, Malkki M, Anasetti C, Martin P, Woolfrey A, et al. The biological significance of HLA -DP gene variation in haematopoietic cell transplan tation. Brit J Haematology. 2001;112:1–8.
11.
Löwenberg B. Post-remission treatment of acute my elogenous leukemia. New Engl J Med. 1995;332:260–2.
12.
Wheatley K, Gray R. Commentary: Mendelian rando mization--an update on its use to evaluate allogeneic stem cell transplantation in leukaemia. Int J Epidemi ology. 2004;33:15–7.
13.
Burnett AK. Current controversies: which patients with acute myeloid leukaemia should receive a bone marr ow transplantation?--an adult treater’s view. Br J Har matol. 2002;118:357–64.
14.
Frassoni F. Randomised studies in acute myeloid leu kaemia: the double truth. Bone Marrow Transplant. 2000;25:471–3.
15.
Suciu S, Mandelli F, Witte T, Zittoun R, Gallo E, Labar B, et al. Allogeneic compared with autologous stem cell transplantation in the treatment of patients younger than 46 years with acute myeloid leukemia (AML) in first complete remission (CR1): an intention to-treat analysis of the EORTC/GIMEMAAML-10 trial. Blood. 2003;
16.
Burnett AK, Wheatley K, Goldstone AH, Stevens RF, Hann IM, Rees JHK, et al. The value of allogeneic bo ne marrow transplant in patients with acute myeloid leukemia at differing risk of relapse: results of the UK MRC AML 10 trial. Brit J Haematology. 2002;118:400.
17.
Jourdan E, Maraninchi D, Reiffers D, Gluckman E, Rio B, Jouet JP, et al. Early allogeneic transplantation fa vorably invluences the outcome of adult patients su ffering from acute myeloid leukemia. Bone Marrow Transplant. 1997;19:875–81.
18.
Mrozek K, Heinonen K, Chapelle A, Bloomfield CD. Clinical significance of cytogenetics in acute mye loid leukemia. Semin Oncol. 1997;24(1):17–31.
19.
Stockerl-Goldstein KE, Blume KG. Allogeneic hema topoietic cell transplantation for adult patients with acute myeloid leukemia. 2004.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
