Journal
HAEMATOLOGICA
Volume 98, Issue 2, Pages 185-192Publisher
FERRATA STORTI FOUNDATION
DOI: 10.3324/haematol.2012.062059
Keywords
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Categories
Funding
- National Cancer Institute (NCI) [24-CA76518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- NHLBI [5U01HL069294]
- NCI
- Health Resources and Services Administration (HRSA/DHHS) [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- Allos, Inc.
- Amgen, Inc.
- Angioblast
- Anonymous donation
- Ariad
- Be the Match Foundation
- Blue Cross
- Blue Shield Association
- Buchanan Family Foundation
- CaridianBCT
- Celgene Corporation
- CellGenix, GmbH
- Children's Leukemia Research Association
- Fresenius-Biotech North America, Inc.
- Gamida Cell Teva Joint Venture Ltd.
- Genentech, Inc.
- Genzyme Corporation
- GlaxoSmithKline
- Kiadis Pharma
- Leukemia & Lymphoma Society
- Medical College of Wisconsin
- Millennium Pharmaceuticals, Inc.
- Milliman USA, Inc.
- Miltenyi Biotec, Inc.
- National Marrow Donor Program
- Optum Healthcare Solutions, Inc.
- Otsuka America Pharmaceutical, Inc.
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix, Inc.
- Swedish Orphan Biovitrum
- THERAKOS, Inc.
- Wellpoint, Inc.
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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.
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