title: Chemotherapy versus transplants for acute myelogenous leukemia in second remission.
abstract: The best therapy for persons with acute myelogenous leukemia (AML) in 2nd remission is unknown. Bone marrow transplants from an HLA-identical sibling are reported to be better than chemotherapy but this is controversial. The objective of the study was to compare 3-year leukemia-free survival (LFS) in comparable subjects receiving chemotherapy or a transplant. 485 persons with AML in 2nd remission were studied. The chemotherapy cohort included 244 persons treated on trials of the British Medical Research Council, Eastern Cooperative Oncology Group and MD Anderson Hospital. The transplant cohort included 257 persons transplanted worldwide and reported to the international Bone Marrow Transplant Registry (16 were also chemotherapy subjects.) Subjects were selected for comparable age and year of treatment. Preliminary analyses identified two factors correlated with LFS: age < or = or > 30 years and 1st remission duration < or = or > 1 year; subsequent analyses were partitioned accordingly. Three-year probabilities of treatment-related mortality with chemotherapy and transplants were 7% (95% confidence interval, 3-15%) vs 56% (49-63%). Three-year leukemia relapse probabilities were 81% (74-86%) vs 41% (33-49%). Three-year probabilities of LFS were 17% (12-23%) vs 26 (20-32%). Cohort analysis showed significantly higher LFS with transplants vs chemotherapy in persons < or = 30 years and 1st remissions > 1 year (41% (29-53%) vs 17% (7-32%); P = 0.017) and those in > 30 years with 1st remissions < or = 1 year (18% (9-29%) vs 7% (2-16%); P = 0.046). Others had comparable LFS with both treatments. These data indicate better LFS with HLA-identical sibling transplants than chemotherapy in some persons with AML in 2nd remission.
authors.affiliation: Salick Health Care, Inc., Division of Bone Marrow and Stem Cell Transplantation, Los Angeles, CA, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: J K
authors.initials: JK
authors.lastname: Rees
authors.forename: R G
authors.initials: RG
authors.lastname: Gray
authors.forename: M M
authors.initials: MM
authors.lastname: Oken
authors.forename: E H
authors.initials: EH
authors.lastname: Estey
authors.forename: K M
authors.initials: KM
authors.lastname: Kim
authors.forename: M J
authors.initials: MJ
authors.lastname: Zhang
authors.forename: R C
authors.initials: RC
authors.lastname: Ash
authors.forename: K
authors.initials: K
authors.lastname: Atkinson
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.forename: K A
authors.initials: KA
authors.lastname: Dicke
authors.forename: J L
authors.initials: JL
authors.lastname: Gajewski
authors.forename: J M
authors.initials: JM
authors.lastname: Goldman
authors.forename: W
authors.initials: W
authors.lastname: Helbig
authors.forename: P S
authors.initials: PS
authors.lastname: Henslee-Downey
authors.forename: W
authors.initials: W
authors.lastname: Hinterberger
authors.forename: N
authors.initials: N
authors.lastname: Jacobsen
authors.forename: A
authors.initials: A
authors.lastname: Keating
authors.forename: J P
authors.initials: JP
authors.lastname: Klein
authors.forename: A M
authors.initials: AM
authors.lastname: Marmont
authors.forename: H G
authors.initials: HG
authors.lastname: Prentice
authors.forename: J
authors.initials: J
authors.lastname: Reiffers
authors.forename: A A
authors.initials: AA
authors.lastname: Rimm
authors.forename: M M
authors.initials: MM
authors.lastname: Bortin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013997:Time Factors; D014184:Transplantation, Homologous