Comparison of Autologous Hematopoietic Cell Transplantation and Chemotherapy as Postremission Treatment in Non-M3 Acute Myeloid Leukemia in First Complete Remission

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• 作者：Kensuke Usuki¹ ; Saiko Kurosawa² ; ^{skurosaw@ncc.go.jp} ; Naoyuki Uchida³ ; Kazuaki Yakushiji⁴ ; Fusako Waki⁵ ; Eijo Matsuishi⁶ ; Kumiko Kagawa⁷ ; Tatsuo Furukawa⁸ ; Yoshinobu Maeda⁹ ; Manabu Shimoyama¹⁰ ; Hiroatsu Ago¹¹ ; Yujiro Yamano¹² ; Shingo Yano¹³ ; Naohito Fujishima¹⁴ ; Yasushi Takamatsu¹⁵ ; Tetsuya Eto¹⁶ ; Michihiro Hidaka¹⁷ ; Hitoshi Matsuoka¹⁸ ; Takahiro Fukuda²
• 关键词：AML ; Autologous transplantation ; CR1 ; inv(16) ; Postremission therapy ; t(8 ; 21)
• 刊名：Clinical Lymphoma Myeloma and Leukemia
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：12
• 期：6
• 页码：444-451
• 全文大小：900 K

文摘

Introduction

A number of randomized trials in patients with AML in CR1 have been conducted and they showed that auto-HCT improves RFS but not OS, compared with chemotherapy. However, because these trials have had compliance problems, the value of auto-HCT still has not been clearly established.

Patients and Methods

Using a database of 2518 adult patients with AML in CR1, we retrospectively analyzed the outcome of auto-HCT and compared it with intensive nonmyeloablative chemotherapy using landmark analyses.

Results

In 103 auto-HCT recipients, OS and RFS at 3 years from treatment were 65 % and 57 % , respectively. Multivariate analysis showed that unfavorable risk cytogenetics and entry into CR1 after 2 courses of induction treatment predicted a poor outcome. Because the median time interval between CR1 and auto-HCT was 153 days, landmark analyses at 5 months after CR1 were performed to compare 1290 patients who received chemotherapy alone (median age, 52 years; range, 16-70) with 103 who received auto-HCT (median age, 48 years; range, 16-67). Auto-HCT improves 3-year RFS (58 % vs. 37 % ; P < .001) but not OS compared with chemotherapy alone. Among patients with unfavorable risk cytogenetics or those who required 2 courses to reach CR1, there was no significant difference in RFS between the 2 groups.

Conclusion

Auto-HCT can be considered as a postremission therapy for AML patients with favorable or intermediate risk cytogenetics who achieve CR1 after a single course of induction treatment.