PURPOSE: To compare intensive chemotherapy and HLA-identical allogeneic bone marrow transplantation (BMT) as postinduction therapy in young adults with acute myeloid leukemia (AML). PATIENTS AND METHODS: Seventy-eight consecutive AML patients younger than 40 years of age were treated according to a prospective protocol in which every patient in complete remission (CR) with an HLA-identical sibling was scheduled to receive BMT rather than intensive chemotherapy consolidation. To minimize comparison biases, the availability or not of an HLA-identical sibling donor was considered to be the equivalent of genetic randomization to the BMT or chemotherapy arm, respectively. RESULTS: Fifty-eight patients (74%) achieved a CR. A donor was found for 27 patients (BMT arm), and 20 of these patients were actually transplanted in first CR. The 31 patients without a donor were allocated to the chemotherapy arm. Patients in the two arms had similar disease characteristics at diagnosis and previous responses to induction therapy. The cumulative risk of relapse was 43% +/- 24% in the BMT arm and 67% +/- 19% in the chemotherapy arm (P = .01). The 7-year leukemia-free survival (LFS) rate was 41% +/- 20% in the BMT arm and 27% +/- 16% in the chemotherapy arm, a difference that is not statistically significant between the two arms. The overall survival rates were 41% +/- 20% and 46% +/- 19%, respectively. CONCLUSION: In this study, the availability of an HLA-identical sibling donor was not associated with a better survival rate because of both the impossibility of some patients with a donor to receive BMT and the more efficient salvage treatment of patients who relapsed after intensive consolidation chemotherapy than of patients who relapsed after BMT.
RCT Entities:
PURPOSE: To compare intensive chemotherapy and HLA-identical allogeneic bone marrow transplantation (BMT) as postinduction therapy in young adults with acute myeloid leukemia (AML). PATIENTS AND METHODS: Seventy-eight consecutive AMLpatients younger than 40 years of age were treated according to a prospective protocol in which every patient in complete remission (CR) with an HLA-identical sibling was scheduled to receive BMT rather than intensive chemotherapy consolidation. To minimize comparison biases, the availability or not of an HLA-identical sibling donor was considered to be the equivalent of genetic randomization to the BMT or chemotherapy arm, respectively. RESULTS: Fifty-eight patients (74%) achieved a CR. A donor was found for 27 patients (BMT arm), and 20 of these patients were actually transplanted in first CR. The 31 patients without a donor were allocated to the chemotherapy arm. Patients in the two arms had similar disease characteristics at diagnosis and previous responses to induction therapy. The cumulative risk of relapse was 43% +/- 24% in the BMT arm and 67% +/- 19% in the chemotherapy arm (P = .01). The 7-year leukemia-free survival (LFS) rate was 41% +/- 20% in the BMT arm and 27% +/- 16% in the chemotherapy arm, a difference that is not statistically significant between the two arms. The overall survival rates were 41% +/- 20% and 46% +/- 19%, respectively. CONCLUSION: In this study, the availability of an HLA-identical sibling donor was not associated with a better survival rate because of both the impossibility of some patients with a donor to receive BMT and the more efficient salvage treatment of patients who relapsed after intensive consolidation chemotherapy than of patients who relapsed after BMT.
Authors: Hagop Kantarjian; Susan O'Brien; Jorge Cortes; William Wierda; Stefan Faderl; Guillermo Garcia-Manero; Jean-Pierre Issa; Elihu Estey; Michael Keating; Emil J Freireich Journal: Cancer Date: 2008-10-01 Impact factor: 6.860
Authors: Markus Pfirrmann; Susanne Saussele; Andreas Hochhaus; Andreas Reiter; Ute Berger; Dieter K Hossfeld; Christoph Nerl; Christof Scheid; Karsten Spiekermann; Jiri Mayer; Andrzej Hellmann; Klaus Lechner; Christiane Falge; Herbert G Sayer; Donald Bunjes; Arnold Ganser; Dietrich W Beelen; Helen Baldomero; Urs Schanz; Hermann Heimpel; Hans-Jochem Kolb; Joerg Hasford; Alois Gratwohl; Rüdiger Hehlmann Journal: J Cancer Res Clin Oncol Date: 2014-04-10 Impact factor: 4.553
Authors: H Link; H J Kolb; W Ebell; D K Hossfeld; A Zander; D Niethammer; H Wandt; H Grosse-Wilde; U W Schaefer Journal: Med Klin (Munich) Date: 1997-09-15
Authors: John Koreth; Richard Schlenk; Kenneth J Kopecky; Sumihisa Honda; Jorge Sierra; Benjamin J Djulbegovic; Martha Wadleigh; Daniel J DeAngelo; Richard M Stone; Hisashi Sakamaki; Frederick R Appelbaum; Hartmut Döhner; Joseph H Antin; Robert J Soiffer; Corey Cutler Journal: JAMA Date: 2009-06-10 Impact factor: 56.272
Authors: G Heil; P S Mitrou; D Hoelzer; M Freund; H Link; G Ehninger; B Steinke; S Ohl; H Wandt; E Fackler-Schwalbe Journal: Ann Hematol Date: 1995-11 Impact factor: 3.673