| Abstract: |
We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95% confidence interval [CI] 2.95-15.45, P < .001), lower relapse (RR 0.47, 95% CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 × 109/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT. © 2008 American Society for Blood and Marrow Transplantation. |
| Keywords: |
cancer chemotherapy; cancer survival; controlled study; treatment outcome; survival rate; treatment failure; transplantation, homologous; acute granulocytic leukemia; major clinical study; leukemia, myeloid, acute; busulfan; clinical trial; comparative study; chemotherapy; cytarabine; methotrexate; drug megadose; recurrence risk; antineoplastic agent; controlled clinical trial; cohort studies; cohort analysis; cyclophosphamide; hematopoietic stem cell transplantation; chromosomes, human, pair 8; cancer mortality; age; siblings; confidence interval; hla matching; whole body radiation; data collection; proportional hazards model; statistical significance; multicenter study; graft versus host reaction; remission induction; allogeneic hematopoietic stem cell transplantation; chromosome translocation; translocation, genetic; leukocyte count; sibling; t cell depletion; cyclosporin a; tacrolimus; leukemia relapse; chromosome loss; germany; graft recipient; autologous hematopoietic stem cell transplantation; leukemia remission; chromosomes, human, pair 21; aml; histocompatibility testing; sex chromosome; t(8; 21)
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