Meng Lv 1 , Yu Wang 1 , Ying-Jun Chang 1 , Xiao-Hui Zhang 1 , Lan-Ping Xu 1 , Qian Jiang 1 , Hao Jiang 1 , Jin Lu 1 , Huan Chen 1 , Wei Han 1 , Feng-Rong Wang 1 , Jing-Zhi Wang 1 , Yao Chen 1 , Chen-Hua Yan 1 , Yuan-Yuan Zhang 1 , Yu-Qian Sun 1 , Xiao-Dong Mo 1 , Hong-Hu Zhu 1 , Jin-Song Jia 1 , Ting Zhao 1 , Jing Wang 1 , Kai-Yan Liu 1 , Xiao-Jun Huang 2,3 Show Affiliations »
Abstract
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PURPOSE: Although myeloablative HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT ) following pretransplant anti-thymocyte globulin (ATG) and granulocyte colony-stimulating factor (G-CSF) stimulated grafts (ATG+G-CSF ) has been confirmed as an alternative to HSCT from HLA-matched sibling donors (MSD), the effect of haplo-HSCT on postremission treatment of patients with acute myeloid leukemia (AML) with intermediate risk (int-risk AML) who achieved first complete remission (CR1 ) has not been defined. PATIENTS AND METHODS: In this prospective trial, among 443 consecutive patients ages 16-60 years with newly diagnosed de novo AML with int-risk cytogenetics, 147 patients with molecular int-risk AML who achieved CR1 within two courses of induction and remained in CR1 at 4 months postremission either received chemotherapy (n = 69) or underwent haplo-HSCT (n = 78). RESULTS: The 3-year leukemia-free survival (LFS) and overall survival (OS ) were significantly higher in the haplo-HSCT group than in the chemotherapy group (74.3% vs. 47.3%; P = 0.0004 and 80.8% vs. 53.5%; P = 0.0001, respectively). In the multivariate analysis with propensity score adjustment, postremission treatment (haplo-HSCT vs. chemotherapy) was an independent risk factor affecting the LFS [HR 0.360; 95% confidence interval (CI), 0.163-0.793; P = 0.011], OS (HR 0.361; 95% CI, 0.156-0.832; P = 0.017), and cumulative incidence of relapse (HR 0.161; 95% CI, 0.057-0.459; P = 0.001) either in entire cohort or stratified by minimal residual disease after the second consolidation. CONCLUSIONS: Myeloablative haplo-HSCT with ATG+G-CSF is superior to chemotherapy as a postremission treatment in patients with int-risk AML during CR1 . Haplo-HSCT might be a first-line postremission therapy for int-risk AML in the absence of HLA-MSDs. Haplo-HSCT might be superior to chemotherapy as a first-line postremission treatment of intermediate-risk AML in CR1. ©2018 American Association for Cancer Research.
RCT Entities: Population
Interventions
Outcomes
PURPOSE: Although myeloablative HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT) following pretransplant anti-thymocyte globulin (ATG) and granulocyte colony-stimulating factor (G-CSF ) stimulated grafts (ATG+G-CSF ) has been confirmed as an alternative to HSCT from HLA-matched sibling donors (MSD ), the effect of haplo-HSCT on postremission treatment of patients with acute myeloid leukemia (AML ) with intermediate risk (int-risk AML ) who achieved first complete remission (CR1 ) has not been defined. PATIENTS AND METHODS: In this prospective trial, among 443 consecutive patients ages 16-60 years with newly diagnosed de novo AML with int-risk cytogenetics, 147 patients with molecular int-risk AML who achieved CR1 within two courses of induction and remained in CR1 at 4 months postremission either received chemotherapy (n = 69) or underwent haplo-HSCT (n = 78). RESULTS: The 3-year leukemia-free survival (LFS) and overall survival (OS) were significantly higher in the haplo-HSCT group than in the chemotherapy group (74.3% vs. 47.3%; P = 0.0004 and 80.8% vs. 53.5%; P = 0.0001, respectively). In the multivariate analysis with propensity score adjustment, postremission treatment (haplo-HSCT vs. chemotherapy) was an independent risk factor affecting the LFS [HR 0.360; 95% confidence interval (CI), 0.163-0.793; P = 0.011], OS (HR 0.361; 95% CI, 0.156-0.832; P = 0.017), and cumulative incidence of relapse (HR 0.161; 95% CI, 0.057-0.459; P = 0.001) either in entire cohort or stratified by minimal residual disease after the second consolidation. CONCLUSIONS: Myeloablative haplo-HSCT with ATG+G-CSF is superior to chemotherapy as a postremission treatment in patients with int-risk AML during CR1 . Haplo-HSCT might be a first-line postremission therapy for int-risk AML in the absence of HLA-MSDs. Haplo-HSCT might be superior to chemotherapy as a first-line postremission treatment of intermediate-risk AML in CR1 . ©2018 American Association for Cancer Research.
Entities: Disease
Gene
Species
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Year: 2018
PMID： 30478089 DOI： 10.1158/1078-0432.CCR-18-1637
Source DB: PubMed Journal: Clin Cancer Res ISSN： 1078-0432 Impact factor: 12.531