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Leukemia. 2019 May 9. doi: 10.1038/s41375-019-0477-x. [Epub ahead of print]

Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60-75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study.

Author information

1
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA. celalettin_ustun@rush.edu.
2
Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, IL, USA. celalettin_ustun@rush.edu.
3
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
4
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
5
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
6
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
7
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
8
Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA.
9
Mayo Clinic, Rochester, MN, USA.
10
University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
11
The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
12
Massachusetts General Hospital, Boston, MA, USA.
13
Agios Pharmaceuticals, Inc, Cambridge, MA, USA.
14
Loyola University Medical Center, Chicago, IL, USA.
15
Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
16
Indiana University Simon Cancer Center, Indianapolis, IN, USA.
17
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
18
Fred Hutchinson Cancer Research Center and Division of Oncology, University of Washington, Seattle, WA, USA.
19
Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.
20
Department of Hematological Malignancies Translational Science, Gehr Family Center for Leukemia Research, Hematologic Malignancies and Stem Cell Transplantation Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA.
21
Weill-Cornell Medical College, New York, NY, USA.
22
Washington University School of Medicine, Saint Louis, MO, USA.
23
Dana-Farber Cancer Institute, Boston, MA, USA.
24
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
25
Adult Hematologic Malignancies & Stem Cell Transplant Section, University Hospitals Seidman Cancer Center, Cleveland, OH, USA.
26
Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
27
Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
28
Duke University, Durham, NC, USA.
29
City of Hope, Duarte, CA, USA.
30
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.

Abstract

The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60-77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5-5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29-0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24-34%) versus CT 13.8% (9-21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.

PMID:
31073153
DOI:
10.1038/s41375-019-0477-x

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