Comparison of Autologous Hematopoietic Cell Transplantation and Chemotherapy as Postremission Treatment in Non-M3 Acute Myeloid Leukemia in First Complete Remission

Randomized trials of acute myeloid leukemia (AML) in first complete remission (CR1) showed that autologous hematopoietic cell transplantation (auto-HCT) improves relapse-free survival (RFS) but not overall survival (OS), compared with chemotherapy. Using a database of 2518 adult patients with AML in CR1, we conducted a 5-month landmark analysis and found that auto-HCT improves 3-year RFS but not OS compared with chemotherapy. Introduction: A number of randomized trials in patients with AML in CR1 have been conducted and they showed that auto-HOT improves RFS but not OS, compared with chemotherapy. However, because these trials have had compliance problems, the value of auto-HOT still has not been clearly established. Patients and Methods: Using a database of 2518 adult patients with AML in CR1, we retrospectively analyzed the outcome of auto-HOT and compared it with intensive nonmyeloablative chemotherapy using landmark analyses. Results: In 103 auto-HOT recipients, OS and RFS at 3 years from treatment were 65% and 57%, respectively. Multivariate analysis showed that unfavorable risk cytogenetics and entry into CR1 after 2 courses of induction treatment predicted a poor outcome. Because the median time interval between CR1 and auto-HOT was 153 days, landmark analyses at 5 months after CR1 were performed to compare 1290 patients who received chemotherapy alone (median age, 52 years; range, 16-70) with 103 who received auto-HOT (median age, 48 years; range, 16-67). Auto-HOT improves 3-year RFS (58% vs. 37%; P <.001) but not OS compared with chemotherapy alone. Among patients with unfavorable risk cytogenetics or those who required 2 courses to reach CR1, there was no significant difference in RFS between the 2 groups. Conclusion: Auto-HOT can be considered as a postremission therapy for AML patients with favorable or intermediate risk cytogenetics who achieve CR1 after a single course of induction treatment. Clinical Lymphoma, Myeloma & Leukemia, Vol. 12, No. 6, 444-51 (C) 2012 Elsevier Inc. All rights reserved.