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Cancer. 2017 Jun 1;123(11):2025-2034. doi: 10.1002/cncr.30536. Epub 2017 Jan 24.

Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission.

Author information

1
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
2
Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
3
Sunesis Pharmaceuticals, San Francisco, California.
4
Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
6
Adult Blood and Marrow Transplant Program, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington.
7
Division of Blood and Marrow Transplantation, Stanford Health Care, Stanford, California.
8
Division of Hematology/Oncology, Barnes Jewish Hospital, St. Louis, Missouri.
9
Hematology/Oncology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia.
10
Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
11
Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
12
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.

Abstract

BACKGROUND:

Patients with acute myeloid leukemia (AML) without complete remission (CR) or in first relapse (Rel1) can have extended leukemia control and survival after allogeneic hematopoietic cell transplantation (HCT). For patients in Rel1 or primary induction failure (PIF), transplantation versus treatment to achieve a second CR (CR2) and subsequent HCT might yield similar outcomes, but available comparative data are scarce.

METHODS:

Survival was analyzed in 4682 HCT recipients according to disease status: PIF (N = 1440), Rel1 (failing ≥1 reinduction; N = 1256), and CR2 (N = 1986).

RESULTS:

Patient, disease, and transplantation characteristics were similar, except that patients in CR2 more often had performance scores of 90% to 100%, de novo AML, and longer CR1 duration. Adverse cytogenetics were more common in patients who experienced PIF. The 5-year survival rate adjusted for performance score, cytogenetic risk, and donor type for CR2 was 39% (95% confidence interval [CI], 37%-41%) compared with 18% (95% CI, 16%-20%) for HCT in Rel1 and 21% (95% CI, 19%-23%) in PIF (P < .0001).

CONCLUSIONS:

Although survival is superior for patients who undergo HCT in CR2, transplantation for selected patients in Rel1 or PIF may still be valuable. These data can guide decision making about additional salvage therapy versus prompt HCT for patients not in CR, but they also highlight that AML is intrinsically more treatable in patients who have favorable-risk cytogenetics, those with longer CR1 duration, and younger patients with better performance status. Cancer 2017;123:2025-2034. © 2017 American Cancer Society.

KEYWORDS:

acute myeloid leukemia; allogeneic transplantation; complete remission; primary induction failure; relapse

PMID:
28117884
PMCID:
PMC5445001
DOI:
10.1002/cncr.30536
[Indexed for MEDLINE]
Free PMC Article

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