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. 2017 Jun 1;123(11):2025-2034.
doi: 10.1002/cncr.30536. Epub 2017 Jan 24.

Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission

Daniel J Weisdorf  1 , Heather R Millard  2 , Mary M Horowitz  2 , Parvinder S Hyare  3 , Richard Champlin  4 , Vincent Ho  5 , Marco Mielcarek  6 , Andrew Rezvani  7 , Keith Stockerl-Goldstein  8 , Hanna J Khoury  9 , Marcos De Lima  10 , Wael Saber  2 , Brenda Sandmaier  11 , Mei Jie Zhang  2   12 , Mary Eapen  2
Affiliations

Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission

Daniel J Weisdorf et al. Cancer. .

Abstract

Background: Patients with acute myeloid leukemia (AML) without complete remission (CR) or in first relapse (Rel1) can have extended leukemia control and survival after allogeneic hematopoietic cell transplantation (HCT). For patients in Rel1 or primary induction failure (PIF), transplantation versus treatment to achieve a second CR (CR2) and subsequent HCT might yield similar outcomes, but available comparative data are scarce.

Methods: Survival was analyzed in 4682 HCT recipients according to disease status: PIF (N = 1440), Rel1 (failing ≥1 reinduction; N = 1256), and CR2 (N = 1986).

Results: Patient, disease, and transplantation characteristics were similar, except that patients in CR2 more often had performance scores of 90% to 100%, de novo AML, and longer CR1 duration. Adverse cytogenetics were more common in patients who experienced PIF. The 5-year survival rate adjusted for performance score, cytogenetic risk, and donor type for CR2 was 39% (95% confidence interval [CI], 37%-41%) compared with 18% (95% CI, 16%-20%) for HCT in Rel1 and 21% (95% CI, 19%-23%) in PIF (P < .0001).

Conclusions: Although survival is superior for patients who undergo HCT in CR2, transplantation for selected patients in Rel1 or PIF may still be valuable. These data can guide decision making about additional salvage therapy versus prompt HCT for patients not in CR, but they also highlight that AML is intrinsically more treatable in patients who have favorable-risk cytogenetics, those with longer CR1 duration, and younger patients with better performance status. Cancer 2017;123:2025-2034. © 2017 American Cancer Society.

Keywords: acute myeloid leukemia; allogeneic transplantation; complete remission; primary induction failure; relapse.

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Conflict of interest statement

All others report no conflicts of interest in the study design or analysis.

Figures

Figure 1
Figure 1
The 5-year probability of overall survival by disease status at transplantation, adjusted for age, performance score, cytogenetic risk and donor type.
Figure 2
Figure 2
Amongst 100 day survivors in CR, the 5-year probability of relapse by disease status at transplantation, adjusted for age, performance score, cytogenetic risk and donor type.
Figure 3
Figure 3
Amongst 100 day survivors in CR, the 5-year probability of non-relapse mortality (NRM) by disease status at transplantation, adjusted for age, performance score, cytogenetic risk and donor type.
See this image and copyright information in PMC

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