Comparison of Reduced-Intensity Hematopoietic Cell Transplantation with Chemotherapy
Posted on 11/29/2011
Comparison of Reduced-Intensity Hematopoietic Cell Transplantation with Chemotherapy in Patients Age 60-70 Years with Acute Myelogenous Leukemia in First Remission
We compared the outcomes of patients age 60-70 years with acute myelogenous leukemia receiving reduced-intensity allogeneic hematopoietic cell transplantation (HCT) in first remission (CR1) reported to the Center for International Blood and Marrow Research (n5 94) with the outcomes in patients treated with induction and postremission chemotherapy on Cancer and Leukemia Group B protocols (n5 96). All patients included had been in CR1 for at least 4 months. The HCTrecipients were slightly younger than the chemotherapy patients (median age, 63 years vs 65 years; P\.001), but there were no significant betweengroup differences in the proportion with therapy-related leukemia or in different cytogenetic risk groups. Time from diagnosis to CR1 was longer for the HCT recipients (median, 44 days vs 38 days; P5.031). Allogeneic HCTwas associated with significantly lower risk of relapse (32% vs 81% at 3 years; P\.001), higher nonrelapse mortality (36% vs 4% at 3 years; P\ .001), and longer leukemia-free survival (32% vs 15% at 3 years; P5.001). Although overall survival was longer for HCTrecipients, the difference was not statistically significant (37% vs 25% at 3 years; P5 .08). Our findings suggest that reducedintensity conditioning allogeneic HCT in patients age 60-70 with acute myelogenous leukemia in CR1 reduces relapse and improves leukemia-free survival. Strategies that reduce nonrelapse mortality may yield significant improvements in overall survival.
Sherif S. Farag, 1 Kati Maharry,2 ,3 Mei-Jie Zhang, 4 Waleska S. Perez, 4 Stephen L. George,3 Krzysztof Mrozek, 2 John DiPersio, 5 Donald W. Bunjes, 6 Guido Marcucci, 2 Maria R. Baer, 7 Mitchell Cairo, 8 Edward Copelan, 9 Corey S. Cutler,10 Luis Isola, 11 Hillard M. Lazarus, 12 Mark R. Litzow,13 David I. Marks,14 Olle Ringden, 15 David A. Rizzieri, 16 Robert Soiffer, 10 Richard A. Larson, 17 Martin S. Tallman, 18 Clara D. Bloomfield, 2 Daniel J. Weisdorf, 19 on behalf of the Acute Leukemia Committee of the Center for International Blood and Marrow Transplant Research and Cancer and Leukemia Group B
Biol Blood Marrow Transplant 17: 1796-1803 (2011) 2011 American Society for Blood and Marrow Transplantation
