Allogeneic Transplantation Versus Chemotherapy as Postremission Therapy for Acute Myeloid Leukemia: A Prospective Matched Pairs Analysis

Abstract

AlloSCT is the most potent postremission therapy for AML and is particularly active for patients 45 to 59 years of age and/or those with high-risk cytogenetics.

Which Acute Myeloid Leukemia Patients Should Be Offered Transplantation?

“…In a validation of the prognostic recommendations from the European LeukemiaNet, patients with CBF (core binding factor) AML had a median OS of 135 months compared to 23 months for patients with normal karyotype AML (NK-AML) and the NPM1mutation/FLT3-negative genotype 21 mutation with no FLT3 ITD (n = 148), that the 3-year RFS rates in the donor and no-donor groups were 83% and 53%, respectively (P = .004), and the 3-year OS rates were 81% and 75%, respectively (P = .300) 22 . These results are in contrast with those of two other retrospective studies of similar patients in which an improvement in RFS with allogeneic transplantation was not found; one of those studies used a similar donor versus no-donor approach, and the other a prospective matched-pairs analysis 15,23 . Further studies and meta-analyses are warranted to define the best post-remission treatment for patients with NPM1 mutated/FLT3 negative profile.…”

“…The poor-risk cytogenetic cohorts can achieve a major benefit of allo-HSCT in CR1, whereas allo-HSCT for the favorable-risk cytogenetic cohort is usually deferred until relapse 14 . In a recent German prospective matched-pair analysis comparing allo-HSCT with chemotherapy as post-remission therapy in AML patients 15 , OS was significantly better for allo-HSCT in patient subgroups with non favorable chromosomal aberrations and patients older than 45 years., It is important to notice that the option for auto-HSCT was not included as post-remission therapy in that study. Moreover, patients receiving reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) regimens were not compared.…”

Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (⩾60 years)

“…1 In addition, allogeneic SCT is the only curative treatment strategy for patients with relapsed/refractory AML or with high-risk myelodysplastic syndrome (MDS). 2 Although the median age at diagnosis is above 65 years for both entities, studies evaluating allogeneic SCT as post-remission therapy or as salvage therapy for patients aged 60 years or older are limited.…”

Characteristics Predicting Outcomes of Allogeneic Stem-Cell Transplantation in Relapsed Acute Myelogenous Leukemia

“…risk group predicts the likelihood of prolonged remission after consolidation therapy, treatment-related mortality is relatively uniform across all cytogenetic risk groups 7,[15][16][17] . Because patients without favourable-risk cytogenetics experience lesser survival with consolidation chemotherapy, ahsct is usually recommended for patients in the adverse prognostic group and sometimes for those in the intermediate prognostic group because the anti-leukemic effect of ahsct generally outweighs the risks and mortality associated with the treatment and is more likely to achieve a favourable result in those patient groups [6][7][8]10,[17][18][19][20] .…”

“…The best consolidation for a specific patient remains controversial and depends on various patient-and disease-related factors, including cytogenetic abnormalities, patient age, comorbidities, and patient wishes 7 . A graft-versus-leukemia effect gives ahsct superior anti-leukemic activity, with a greater chance of maintaining remission than is achieved with consolidation chemotherapy 8,9 . However, its benefit is limited by greater treatment-related mortality, which can be as high as 20%-30%, and the morbidity and mortality associated with graft-versus-host disease (gvhd) 6,8,[10][11][12] .…”