Journal Article

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

Le-Rademacher, Jennifer, Cripe, Larry D., Roboz, Gail J., Major, Brittny, Litzow, Mark R., Hurria, Arti, Tallman, Martin S., Lafky, Jacqueline M., Sandmaier, Brenda M., Appelbaum, Frederick, Storrick, Elizabeth, Nand, Such, Foran, James M., Artz, Andrew S., Bloomfield, Clara D., Attar, Eyal C., Marcucci, Guido, Wang, Hai-Lin, Larson, Richard A., Uy, Geoffrey L., Shea, Thomas C., de Lima, Marcos, Chow, Selina, Erba, Harry P., Jatoi, Aminah, Sun, Zhuoxin, Othus, Megan, Zhang, Mei-Jie, Stone, Richard M., Weisdorf, Daniel J., Mrózek, Krzysztof, Ustun, Celalettin

2019

Overview

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.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/67/1059/99 / 631/67/71 / 96/100 / Acute myeloid leukemia / Aged / Antineoplastic Agents - therapeutic use / Cancer / Cancer Research / Chemotherapy / Clinical trials / Consolidation / Critical Care Medicine / Cytogenetics / Disease-Free Survival / Female / Hematology / Hematopoietic Stem Cell Transplantation / Hematopoietic stem cells / Humans / Intensive / Internal Medicine / Leukemia / Leukemia, Myeloid, Acute - drug therapy / Leukemia, Myeloid, Acute - therapy / Male / Medicine / Medicine & Public Health / Middle Aged / Multivariate Analysis / Myeloid leukemia / Oncology / Patients / Remission / Remission (Medicine) / Remission Induction / Retrospective Studies / Risk Factors / Stem cell transplantation / Survival / Transplantation / Transplantation, Homologous / Treatment Outcome / United States