Steven M Devine1, Kouros Owzar2, William Blum2, Flora Mulkey2, Richard M Stone2, Jack W Hsu2, Richard E Champlin2, Yi-Bin Chen2, Ravi Vij2, James Slack2, Robert J Soiffer2, Richard A Larson2, Thomas C Shea2, Vera Hars2, Alexander B Sibley2, Sergio Giralt2, Shelly Carter2, Mary M Horowitz2, Charles Linker2, Edwin P Alyea2. 1. Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA. steven.devine@osumc.edu. 2. Steven M. Devine and William Blum, Ohio State University, Columbus, OH; Kouros Owzar, Flora Mulkey, Vera Hars, and Alexander B. Sibley, Alliance Statistics and Data Center, Duke University, Durham; Thomas C. Shea, University of North Carolina, Chapel Hill, NC; Richard M. Stone, Robert J. Soiffer, and Edwin P. Alyea, Dana-Farber Cancer Institute; Yi-Bin Chen, Massachusetts General Hospital, Boston, MA; Jack W. Hsu, University of Florida, Gainesville, FL; Richard E. Champlin, MD Anderson Cancer Research Center, Houston, TX; Ravi Vij, Washington University, St. Louis, MO; James Slack, Mayo Clinic, Scottsdale, AZ; Richard A. Larson, University of Chicago, Chicago, IL; Sergio Giralt, Memorial Sloan Kettering Cancer Center, New York, NY; Shelly Carter, The EMMES Corporation, Bethesda, MD; Mary M. Horowitz, Medical College of Wisconsin, Milwaukee, WI; and Charles Linker, University of California at San Francisco, San Francisco, CA.
Abstract
PURPOSE: Long-term survival rates for older patients with newly diagnosed acute myeloid leukemia (AML) are extremely low. Previous observational studies suggest that allogeneic hematopoietic stem-cell transplantation (HSCT) may improve overall survival (OS) because of lower rates of relapse. We sought to prospectively determine the value of HSCT for older patients with AML in first complete remission. PATIENTS AND METHODS: We conducted a prospective multicenter phase II study to assess the efficacy of reduced-intensity conditioning HSCT for patients between the ages of 60 and 74 years with AML in first complete remission. The primary end point was disease-free survival at 2 years after HSCT. Secondary end points included nonrelapse mortality (NRM), graft-versus-host disease (GVHD), relapse, and OS. RESULTS: In all, 114 patients with a median age of 65 years received transplantations. The majority (52%) received transplantations from unrelated donors and were given antithymocyte globulin for GVHD prophylaxis. Disease-free survival and OS at 2 years after transplantation were 42% (95% CI, 33% to 52%) and 48% (95% CI, 39% to 58%), respectively, for the entire group and 40% (95% CI, 29% to 55%) and 50% (95% CI, 38% to 64%) for the unrelated donor group. NRM at 2 years was 15% (95% CI, 8% to 21%). Grade 2 to 4 acute GVHD occurred in 9.6% (95% CI, 4% to 15%) of patients, and chronic GVHD occurred in 28% (95% CI, 19% to 36%) of patients. The cumulative incidence of relapse at 2 years was 44% (95% CI, 35% to 53%). CONCLUSION: Reduced-intensity conditioning HSCT to maintain remission in selected older patients with AML is relatively well tolerated and appears to provide superior outcomes when compared with historical patients treated without HSCT. GVHD and NRM rates were lower than expected. Future transplantation studies in these patients should focus on further reducing the risk of relapse.
PURPOSE: Long-term survival rates for older patients with newly diagnosed acute myeloid leukemia (AML) are extremely low. Previous observational studies suggest that allogeneic hematopoietic stem-cell transplantation (HSCT) may improve overall survival (OS) because of lower rates of relapse. We sought to prospectively determine the value of HSCT for older patients with AML in first complete remission. PATIENTS AND METHODS: We conducted a prospective multicenter phase II study to assess the efficacy of reduced-intensity conditioning HSCT for patients between the ages of 60 and 74 years with AML in first complete remission. The primary end point was disease-free survival at 2 years after HSCT. Secondary end points included nonrelapse mortality (NRM), graft-versus-host disease (GVHD), relapse, and OS. RESULTS: In all, 114 patients with a median age of 65 years received transplantations. The majority (52%) received transplantations from unrelated donors and were given antithymocyte globulin for GVHD prophylaxis. Disease-free survival and OS at 2 years after transplantation were 42% (95% CI, 33% to 52%) and 48% (95% CI, 39% to 58%), respectively, for the entire group and 40% (95% CI, 29% to 55%) and 50% (95% CI, 38% to 64%) for the unrelated donor group. NRM at 2 years was 15% (95% CI, 8% to 21%). Grade 2 to 4 acute GVHD occurred in 9.6% (95% CI, 4% to 15%) of patients, and chronic GVHD occurred in 28% (95% CI, 19% to 36%) of patients. The cumulative incidence of relapse at 2 years was 44% (95% CI, 35% to 53%). CONCLUSION: Reduced-intensity conditioning HSCT to maintain remission in selected older patients with AML is relatively well tolerated and appears to provide superior outcomes when compared with historical patients treated without HSCT. GVHD and NRM rates were lower than expected. Future transplantation studies in these patients should focus on further reducing the risk of relapse.
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