Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 20, Issue 2, Pages 202-208Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2013.10.023
Keywords
AML; RIC; Cytarabine consolidation
Categories
Funding
- Public Health Service from the National Cancer Institute (NCI) [U24 CA076518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases
- NHLBI [U10 HL069294]
- NCI
- Health Resources and Services Administration/US Department of Health and Human Services [HHSH250201200016C]
- Office of Naval Research [N00014-12-1-0142, N00014-13-1-0039]
- Allos Therapeutics, Inc.
- Amgen, Inc.
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The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P = .16). Disease-free survival was 34% (95% Cl, 27% to 41%) and 41% (95% CI, 35% to 46%; P = .15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% Cl, 33% to 43%), respectively (P = .80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning Ha, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required. (C) 2014 American Society for Blood and Marrow Transplantation.
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