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Biol Blood Marrow Transplant. 2014 Feb;20(2):202-8. doi: 10.1016/j.bbmt.2013.10.023. Epub 2013 Nov 1.

Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission.

Author information

1
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: ewarlick@umn.edu.
2
Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada.
3
Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Department of Oncology, Baylor University Medical Center, Dallas, Texas.
5
Department of Pediatrics, Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
6
Department of Hematology, Christian Medical College Hospital, Vellore, India.
7
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
8
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
9
Bristol Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom.
10
Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, Georgia.
11
Universitaire de Liege, Centre Hospitalier Universitaire - Sart-Tilman, Liege, Belgium.
12
Department of Hematopoietic Stem Cell Transplant Program, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas.
13
Service d'Hematologie, Hopital Saint Louis, Paris, France.
14
SCTCT Program, Banner MD Anderson Cancer Center, Gilbert, Arizona.
15
Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
16
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
17
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
18
Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
19
Department of Hematology, University Hospital, Grenoble, France.
20
Medizinische Klinik und Poliklinik I, Universitatsklinikum Carl Gustav Carus, Dresden, Germany.
21
Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York.
22
Hematopoietic Cell Transplantation Program, University of Virginia, Charlottesville, Virginia.
23
Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
24
Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
25
Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom.
26
Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
27
Washington University School of Medicine, St. Louis, Missouri.
28
Weill Cornell Medical College, New York, New York.
29
Department of BMT, Massachusetts General Hospital, Boston, Massachusetts.
30
Department of Hematology/Oncology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York.
31
Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas.
32
Department of Hematology and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota.

Abstract

The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P = .16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P = .15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P = .80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.

KEYWORDS:

AML; Cytarabine consolidation; RIC

Comment in

PMID:
24184335
PMCID:
PMC3924751
DOI:
10.1016/j.bbmt.2013.10.023
[Indexed for MEDLINE]
Free PMC Article

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