PURPOSE: The majority of patients with acute myeloid leukemia (AML) who achieve complete remission (CR) relapse with conventional postremission chemotherapy. Allogeneic stem-cell transplantation (alloSCT) might improve survival at the expense of increased toxicity. It remains unknown for which patients alloSCT is preferable. PATIENTS AND METHODS: We compared the outcome of 185 matched pairs of a large multicenter clinical trial (AMLCG99). Patients younger than 60 years who underwent alloSCT in first remission (CR1) were matched to patients who received conventional postremission therapy. The main matching criteria were AML type, cytogenetic risk group, patient age, and time in first CR. RESULTS: In the overall pairwise compared AML population, the projected 7-year overall survival (OS) rate was 58% for the alloSCT and 46% for the conventional postremission treatment group (P = .037; log-rank test). Relapse-free survival (RFS) was 52% in the alloSCT group compared with 33% in the control group (P < .001). OS was significantly better for alloSCT in patient subgroups with nonfavorable chromosomal aberrations, patients older than 45 years, and patients with secondary AML or high-risk myelodysplastic syndrome. For the entire patient cohort, postremission therapy was an independent factor for OS (hazard ratio, 0.66; 95% CI, 0.49 to 0.89 for alloSCT v conventional chemotherapy), among age, cytogenetics, and bone marrow blasts after the first induction cycle. CONCLUSION: AlloSCT is the most potent postremission therapy for AML and is particularly active for patients 45 to 59 years of age and/or those with high-risk cytogenetics.
PURPOSE: The majority of patients with acute myeloid leukemia (AML) who achieve complete remission (CR) relapse with conventional postremission chemotherapy. Allogeneic stem-cell transplantation (alloSCT) might improve survival at the expense of increased toxicity. It remains unknown for which patients alloSCT is preferable. PATIENTS AND METHODS: We compared the outcome of 185 matched pairs of a large multicenter clinical trial (AMLCG99). Patients younger than 60 years who underwent alloSCT in first remission (CR1) were matched to patients who received conventional postremission therapy. The main matching criteria were AML type, cytogenetic risk group, patient age, and time in first CR. RESULTS: In the overall pairwise compared AML population, the projected 7-year overall survival (OS) rate was 58% for the alloSCT and 46% for the conventional postremission treatment group (P = .037; log-rank test). Relapse-free survival (RFS) was 52% in the alloSCT group compared with 33% in the control group (P < .001). OS was significantly better for alloSCT in patient subgroups with nonfavorable chromosomal aberrations, patients older than 45 years, and patients with secondary AML or high-risk myelodysplastic syndrome. For the entire patient cohort, postremission therapy was an independent factor for OS (hazard ratio, 0.66; 95% CI, 0.49 to 0.89 for alloSCT v conventional chemotherapy), among age, cytogenetics, and bone marrow blasts after the first induction cycle. CONCLUSION: AlloSCT is the most potent postremission therapy for AML and is particularly active for patients 45 to 59 years of age and/or those with high-risk cytogenetics.
Authors: J Versluis; F E M In 't Hout; R Devillier; W L J van Putten; M G Manz; M-C Vekemans; M-C Legdeur; J R Passweg; J Maertens; J Kuball; B J Biemond; P J M Valk; B A van der Reijden; G Meloni; H C Schouten; E Vellenga; T Pabst; R Willemze; B Löwenberg; G Ossenkoppele; F Baron; G Huls; J J Cornelissen Journal: Leukemia Date: 2016-06-24 Impact factor: 11.528
Authors: T Büchner; U O Krug; R Peter Gale; A Heinecke; M C Sauerland; C Haferlach; S Schnittger; T Haferlach; C Müller-Tidow; M Stelljes; R M Mesters; H L Serve; J Braess; K Spiekermann; P Staib; A Grüneisen; A Reichle; L Balleisen; H Eimermacher; A Giagounidis; H Rasche; E Lengfelder; D Görlich; A Faldum; W Köpcke; R Hehlmann; B J Wörmann; W E Berdel; W Hiddemann Journal: Leukemia Date: 2016-03-11 Impact factor: 11.528
Authors: Erica D Warlick; Regis Peffault de Latour; Ryan Shanley; Marie Robin; Nelli Bejanyan; Alienor Xhaard; Claudio Brunstein; Flore Sicre de Fontbrune; Celalettin Ustun; Daniel J Weisdorf; Gerard Socie Journal: Biol Blood Marrow Transplant Date: 2014-11-06 Impact factor: 5.742
Authors: U Krug; W E Berdel; R P Gale; C Haferlach; S Schnittger; C Müller-Tidow; J Braess; K Spiekermann; P Staib; D Beelen; H Serve; C Schliemann; M Stelljes; L Balleisen; G Maschmeyer; A Grüneisen; H Eimermacher; A Giagounidis; H Rasche; R Hehlmann; E Lengfelder; E Thiel; A Reichle; C Aul; W-D Ludwig; W Kern; T Haferlach; W Köpcke; D Görlich; M C Sauerland; A Heinecke; B J Wörmann; W Hiddemann; T Büchner Journal: Leukemia Date: 2016-02-09 Impact factor: 11.528