Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: A registry study from the center for international blood and marrow transplantation research Journal Article


Authors: Keating, A.; DaSilva, G.; Pérez, W. S.; Gupta, V.; Cutler, C. S.; Ballen, K. K.; Cairo, M. S.; Camitta, B. M.; Champlin, R. E.; Gajewski, J. L.; Lazarus, H. M.; Lill, M.; Marks, D. I.; Nabhan, C.; Schiller, G. J.; Socié, G.; Szer, J.; Tallman, M. S.; Weisdorf, D. J.
Article Title: Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: A registry study from the center for international blood and marrow transplantation research
Abstract: The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission. © 2013 Ferrata Storti Foundation.
Keywords: adult; acute granulocytic leukemia; major clinical study; overall survival; mortality; cytarabine; follow up; cytogenetics; karnofsky performance status; sibling; hla typing; autologous peripheral blood stem cell transplantation; leukemia remission; recurrence free survival; disease registry; allogeneic peripheral blood stem cell transplantation
Journal Title: Haematologica
Volume: 98
Issue: 2
ISSN: 0390-6078
Publisher: Ferrata Storti Foundation  
Date Published: 2013-02-01
Start Page: 185
End Page: 192
Language: English
PROVIDER: scopus
PMCID: PMC3561424
PUBMED: 22983587
DOI: 10.3324/haematol.2012.062059
DOI/URL:
Notes: --- - "Export Date: 1 May 2013" - "CODEN: HAEMA" - ":doi 10.3324/haematol.2012.062059" - ": Chemicals/CAScytarabine, 147-94-4, 69-74-9" - "Source: Scopus"
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  1. Martin Stuart Tallman
    596 Tallman