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. 2023 Jan;12(2):1482-1491.
doi: 10.1002/cam4.5039. Epub 2022 Jul 26.

Autologous stem cell transplantation (ASCT) for acute myeloid leukemia in patients in first complete remission after one versus two induction courses: A study from the ALWP of the EBMT

Arnon Nagler  1 , Jacques-Emmanuel Galimard  2 , Myriam Labopin  2   3   4 , Didier Blaise  5 , William Arcese  6 , Silvia Maria Trisolini  7 , Depei Wu  8 , Arnaud Pigneux  9 , Gwendolyn Van Gorkom  10 , Marie-Thérèse Rubio  11 , Tobias Gedde-Dahl  12 , Anne Huynh  13 , Francesco Lanza  14 , Norbert-Claude Gorin  3   4 , Mohamad Mohty  3   4
Affiliations

Autologous stem cell transplantation (ASCT) for acute myeloid leukemia in patients in first complete remission after one versus two induction courses: A study from the ALWP of the EBMT

Arnon Nagler et al. Cancer Med. 2023 Jan.

Abstract

Background: Achieving complete remission (CR) is the main goal in AML treatment and a prerequisite for successful autologous stem cell transplantation (ACT).

Methods: Comparing results of peripheral blood ACT in patients with AML in CR1 attained following 1 versus 2 chemotherapy courses transplanted in 2000-2019.

Results: Patients 1532 (84%) with one and 293 (16%) patients with two induction chemotherapies courses (a total of 1825 patients) were included in the study. Follow-up was 7.9 (95% CI: 7.4-8.4) and 7.7 (95% CI: 7.0-8.6) years (p = 0.8). Time from diagnosis to ACT was 4.7 (range, 3.9-5.8) versus 5.7 (range, 4.7-7.1) months (p < 0.001), respectively. Leukemia free survival (LFS) and overall survival (OS) at 5 years were inferior for patients achieving CR1 with 2 versus 1 course of chemotherapy: 26.6% versus 41.7% (HR = 1.42 [95% CI: 1.22-1.66], p < 0.001) and 36.2% versus 53.3%, (HR = 1.48 [95% CI: 1.25-1.75], p < 0.001), and 5-year relapse incidence (RI) was higher: 67.2% versus 52.3%, (HR = 1.46 [95% CI: 1.25-1.72], p < 0.001). Five-year non-relapse mortality (NRM) was 6.2% versus 6.0% for patients with 2 versus 1 chemotherapy courses, and did not differ significantly (HR = 1.31 [95% CI: 0.81-2.10], p = 0.27).

Conclusions: LFS and OS were inferior and relapse rate was higher in AML patients who received two inductions chemotherapy courses to reach CR1 before being autografted. AML patients who required 2 induction courses to achieve remission, may be offered allogeneic transplantation rather than an autologous one in an attempt to reduce their high RI and improve outcomes.

Keywords: acute myeloid leukemia; autologous; complete remission; induction chemotherapy; stem cell transplantation.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

FIGURE 1
FIGURE 1
Autologous transplantation outcome – Non‐relapse mortality (NRM), relapse incidence (RI), leukemia‐free survival (LFS) and overall survival (OS) in patients with AML with one and two induction courses.
See this image and copyright information in PMC

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