TY - JOUR
T1 - Autologous or allogeneic stem cell transplantation as post-remission therapy in refractory or relapsed acute myeloid leukemia after highly intensive chemotherapy
AU - Thomas, Xavier
AU - Le, Q. H.
AU - de Botton, S.
AU - Raffoux, E.
AU - Chelghoum, Y.
AU - Pautas, C.
AU - Freyfus, F.
AU - Dhedin, N.
AU - Vekhoff, A.
AU - Troncy, J.
AU - Pigneux, A.
AU - de Revel, T.
AU - Reman, O.
AU - Travade, P.
AU - Thiebaut, A.
AU - Guerci, A.
AU - Elhamri, M.
AU - Fenaux, P.
AU - Dombret, H.
AU - Michallet, M.
PY - 2005/7/25
Y1 - 2005/7/25
N2 - Post-remission options were compared in a population of 262 relapsing and refractory acute myeloid leukemia patients achieving complete remission (CR) after the same re-induction according to etoposide-mitoxantrone-cytarabine (EMA) trials. The selection of post-remission therapy depended on trial recommendations, age, performance status, and availability of an HLA-identical sibling. One hundred and thirty patients received chemotherapy consolidation courses, 50 received autologous stem cell transplantation (SCT), and 43 underwent allogeneic bone marrow transplantation (BMT), while 39 did not receive any additional therapy. The preliminary analysis identified 3 favorable prognostic factors correlated with event-free survival (EFS): M3 subtype, previous CR duration > 1 year, and transplantation. Three year EFS was 68 vs. 23% with autologous SCT and allogeneic BMT in M3 patients and, respectively, 41 vs. 20% in non-M3 patients. Three year probabilities of treatment-related mortality were 11 and 47%, respectively. A statistical model was conceived with adjustment on prognostic factors and post-remission option. In the multivariate analysis, autologous SCT appeared significantly better than allogeneic BMT (P < 0.01) or chemotherapy (P=0.001), while allogeneic BMT was not statistically different than chemotherapy. This indicates a high treatment-related toxicity with allogeneic BMT in patients re-induced by highly intensive chemotherapy, and therefore a tendency for a better outcome with autologous SCT as post-remission treatment in those patients.
AB - Post-remission options were compared in a population of 262 relapsing and refractory acute myeloid leukemia patients achieving complete remission (CR) after the same re-induction according to etoposide-mitoxantrone-cytarabine (EMA) trials. The selection of post-remission therapy depended on trial recommendations, age, performance status, and availability of an HLA-identical sibling. One hundred and thirty patients received chemotherapy consolidation courses, 50 received autologous stem cell transplantation (SCT), and 43 underwent allogeneic bone marrow transplantation (BMT), while 39 did not receive any additional therapy. The preliminary analysis identified 3 favorable prognostic factors correlated with event-free survival (EFS): M3 subtype, previous CR duration > 1 year, and transplantation. Three year EFS was 68 vs. 23% with autologous SCT and allogeneic BMT in M3 patients and, respectively, 41 vs. 20% in non-M3 patients. Three year probabilities of treatment-related mortality were 11 and 47%, respectively. A statistical model was conceived with adjustment on prognostic factors and post-remission option. In the multivariate analysis, autologous SCT appeared significantly better than allogeneic BMT (P < 0.01) or chemotherapy (P=0.001), while allogeneic BMT was not statistically different than chemotherapy. This indicates a high treatment-related toxicity with allogeneic BMT in patients re-induced by highly intensive chemotherapy, and therefore a tendency for a better outcome with autologous SCT as post-remission treatment in those patients.
KW - Acute myeloid leukemia
KW - Autologous transplantation
KW - Relapse
KW - Resistance
KW - Sequential chemotherapy
UR - http://www.scopus.com/inward/record.url?scp=22144487423&partnerID=8YFLogxK
U2 - 10.1080/10428190500084837
DO - 10.1080/10428190500084837
M3 - Article
C2 - 16019551
AN - SCOPUS:22144487423
SN - 1042-8194
VL - 46
SP - 1007
EP - 1016
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 7
ER -