Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years

• Published in: Leukemia Vol. 29; no. 5; pp. 1041 - 1050
• Main Authors: Cornelissen, J J, Versluis, J, Passweg, J R, van Putten, W L J, Manz, M G, Maertens, J, Beverloo, H B, Valk, P J M, van Marwijk Kooy, M, Wijermans, P W, Schaafsma, M R, Biemond, B J, Vekemans, M-C, Breems, D A, Verdonck, L F, Fey, M F, Jongen-Lavrencic, M, Janssen, J J W M, Huls, G, Kuball, J, Pabst, T, Graux, C, Schouten, H C, Gratwohl, A, Vellenga, E, Ossenkoppele, G, Löwenberg, B
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.05.2015; Nature Publishing Group
• Subjects: 692/308/174; 692/699/1541/1990/283/1897; 692/699/67/1059/99; 692/700/565/2319; 692/700/565/545/576/1955; Acute myeloid leukemia; Adult; Antineoplastic Agents - chemistry; Autografts; Cancer; Cancer Research; Chemotherapy; Conditioning; Critical Care Medicine; Disease-Free Survival; Female; Health aspects; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Intensive; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Myeloid leukemia; Oncology; original-article; Proportional Hazards Models; Remission; Remission (Medicine); Remission Induction; Risk; Stem cell transplantation; Stem cells; Survival; Time dependence; Time Factors; Transplantation; Transplantation Conditioning - methods; Transplantation, Homologous; Treatment Outcome; France
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/leu.2014.332

The preferred type of post-remission therapy (PRT) in patients with acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate, especially in patients at higher risk of nonrelapse mortality (NRM), including patients >40 years of age. We report results of a time-dependent multivariable analysis of allogenic hematopoietic stem cell transplantation (alloHSCT) ( n =337) versus chemotherapy ( n =271) or autologous HSCT (autoHSCT) ( n =152) in 760 patients aged 40–60 years with AML in CR1. Patients receiving alloHSCT showed improved overall survival (OS) as compared with chemotherapy (respectively, 57±3% vs 40±3% at 5 years, P <0.001). Comparable OS was observed following alloHSCT and autoHSCT in patients with intermediate-risk AML (60±4 vs 54±5%). However, alloHSCT was associated with less relapse (hazard ratio (HR) 0.51, P <0.001) and better relapse-free survival (RFS) (HR 0.74, P =0.029) as compared with autoHSCT in intermediate-risk AMLs. AlloHSCT was applied following myeloablative conditioning ( n =157) or reduced intensity conditioning ( n =180), resulting in less NRM, but comparable outcome with respect to OS, RFS and relapse. Collectively, these results show that alloHSCT is to be preferred over chemotherapy as PRT in patients with intermediate- and poor-risk AML aged 40–60 years, whereas autoHSCT remains a treatment option to be considered in patients with intermediate-risk AML.