K Heidrich1, C Thiede2, K Schäfer-Eckart3, N Schmitz4, W E Aulitzky5, A Krämer6, W Rösler7, M Hänel8, H Einsele9, C D Baldus10, R U Trappe11, F Stölzel2, J M Middeke2, C Röllig2, F Taube2, M Kramer2, H Serve12, W E Berdel13, G Ehninger2, M Bornhäuser14, J Schetelig2. 1. Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden. Electronic address: katharina.heidrich@uniklinikum-dresden.de. 2. Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden. 3. Medical Clinic 5, Paracelsus Medical University, Nuremberg. 4. Asklepios Hospital St. Georg, Hamburg. 5. Department of Hematology, Oncology and Palliative Care, Robert-Bosch-Hospital, Stuttgart. 6. Department of Internal Medicine V, Medical University Clinic, Heidelberg. 7. Medical Clinic 5, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen. 8. Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz. 9. Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg. 10. Division of Hematology, Oncology and Tumor Immunology, Medical Department, Charité-Universitätsmedizin Berlin, Berlin. 11. Medical Clinic II, DIAKO Ev. Diakonie-Krankenhaus gGmbH, Bremen. 12. Medical Clinic II, University Hospital Frankfurt, Frankfurt. 13. Medical Clinic A, University Hospital Münster, Münster. 14. Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden; National Center for Tumor Diseases, Dresden, Germany.
Abstract
BACKGROUND: The value of allogeneic hematopoietic cell transplantation (alloHCT) as postremission treatment is not well defined for patients with intermediate-risk acute myeloid leukemia (AML) without FLT3-ITD, biallelic CEBPA-, or NPM1 mutations (here referred to as NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML) in first complete remission (CR1). PATIENTS AND METHODS: We addressed this question using data from two prospective randomized controlled trials on intensive induction- and risk-stratified postremission therapy. The NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML subgroup comprised 497 patients, aged 18-60 years. RESULTS: In donor versus no-donor analyses, patients with a matched related donor had a longer relapse-free survival (HR 0.5; 95% CI 0.3-0.9, P = 0.02) and a trend toward better overall survival (HR 0.6, 95% CI 0.3-1.1, P = 0.08) compared with patients who received postremission chemotherapy. Notably, only 58% of patients in the donor group were transplanted in CR1. We therefore complemented the donor versus no-donor analysis with multivariable Cox regression analyses, where alloHCT was tested as a time-dependent covariate: overall survival (HR 0.58, 95% CI 0.37-0.9, P = 0.02) and relapse-free survival (HR 0.51, 95% CI 0.34-0.76; P = 0.001) for patients who received alloHCT compared with chemotherapy in CR1 were significantly longer. CONCLUSION: Outside clinical trials, alloHCT should be the preferred postremission treatment of patients with intermediate risk NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML in CR1. CINICALTRIALS.GOV IDENTIFIER: NCT00180115, NCT00180102.
BACKGROUND: The value of allogeneic hematopoietic cell transplantation (alloHCT) as postremission treatment is not well defined for patients with intermediate-risk acute myeloid leukemia (AML) without FLT3-ITD, biallelic CEBPA-, or NPM1 mutations (here referred to as NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML) in first complete remission (CR1). PATIENTS AND METHODS: We addressed this question using data from two prospective randomized controlled trials on intensive induction- and risk-stratified postremission therapy. The NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML subgroup comprised 497 patients, aged 18-60 years. RESULTS: In donor versus no-donor analyses, patients with a matched related donor had a longer relapse-free survival (HR 0.5; 95% CI 0.3-0.9, P = 0.02) and a trend toward better overall survival (HR 0.6, 95% CI 0.3-1.1, P = 0.08) compared with patients who received postremission chemotherapy. Notably, only 58% of patients in the donor group were transplanted in CR1. We therefore complemented the donor versus no-donor analysis with multivariable Cox regression analyses, where alloHCT was tested as a time-dependent covariate: overall survival (HR 0.58, 95% CI 0.37-0.9, P = 0.02) and relapse-free survival (HR 0.51, 95% CI 0.34-0.76; P = 0.001) for patients who received alloHCT compared with chemotherapy in CR1 were significantly longer. CONCLUSION: Outside clinical trials, alloHCT should be the preferred postremission treatment of patients with intermediate risk NPM1mut-neg/CEBPAdm-neg/FLT3-ITDneg AML in CR1. CINICALTRIALS.GOV IDENTIFIER: NCT00180115, NCT00180102.
Authors: Qiushi Wei; Bin Wang; Hailan Hu; Chuhai Xie; Long Ling; Jianliang Gao; Yanming Cao Journal: Int J Mol Med Date: 2020-01-20 Impact factor: 4.101