title: Comparison of autologous bone marrow transplantation and intensive chemotherapy as postremission therapy in adult acute myeloid leukemia. The Groupe Ouest Est Leucémies Aiguës Myéloblastiques (GOELAM).
abstract: Three intensive consolidation strategies are currently proposed to younger adults with acute myeloid leukemia (AML) in first complete remission (CR): allogeneic or autologous bone marrow transplantation (BMT) and intensive consolidation chemotherapy (ICC). Patients aged 15 to 50 years with de novo AML received an induction treatment with 7 days of cytarabine and either idarubicin or rubidazone. After achievement of a CR, patients up to the age of 40 and having an HLA-identical sibling were assigned to undergo an allogeneic BMT. All the other patients received a first course of ICC with high-dose cytarabine and the same anthracycline as for induction. They were then randomly assigned to either receive a second course of ICC with amsacrine and etoposide or a combination of busulfan and cyclosphosphamide followed by an unpurged autologous BMT. Of 517 eligible patients, 367 had a CR, but only 219 (59.5%) actually received the planned intensive postremission treatment (73 allogeneic BMT, 75 autologous BMT, and 71 ICC). With a median follow-up of 62 months, the 4-year disease-free survival (DFS) of the 367 patients in CR was 39.5%. The 4-year overall survival (OS) of the 517 eligible patients was 40.5%. In multivariate analysis, DFS and OS were influenced only by the initial white blood cell count and by the French-American-British classification. The type of postremission therapy had no significant impact on the outcome. There was no difference in the 4-year DFS and OS between 88 patients for whom an allogeneic BMT was scheduled (respectively, 44% and 53%) and 134 patients of the same age category and without an HLA-identical sibling (respectively, 38% and 53%). Similarly, there was no difference in the outcome between autologous BMT and ICC. The 4-year DFS was 44% for the 86 patients randomly assigned to autologous BMT and 40% for the 78 patients assigned to ICC (P = .41). The 4-year OS was similar in the two groups (50% v 54.5%, P = .72). The median duration of hospitalization and thrombocytopenia were longer after autologous BMT (39 v 32 days, P = .006, and 109.5 v 18.5 days, P = .0001, respectively). After a first course of ICC, a second course of chemotherapy is less myelotoxic than an unpurged autologous BMT but yields comparable DFS and OS rates.
authors.affiliation: Department of Hematology of Centre Hospitalier Universitaire de Nantes, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Harousseau
authors.forename: J Y
authors.initials: JY
authors.lastname: Cahn
authors.forename: B
authors.initials: B
authors.lastname: Pignon
authors.forename: F
authors.initials: F
authors.lastname: Witz
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.forename: M
authors.initials: M
authors.lastname: Delain
authors.forename: B
authors.initials: B
authors.lastname: Lioure
authors.forename: T
authors.initials: T
authors.lastname: Lamy
authors.forename: B
authors.initials: B
authors.lastname: Desablens
authors.forename: F
authors.initials: F
authors.lastname: Guilhot
authors.forename: D
authors.initials: D
authors.lastname: Caillot
authors.forename: J F
authors.initials: JF
authors.lastname: Abgrall
authors.forename: S
authors.initials: S
authors.lastname: Francois
authors.forename: J
authors.initials: J
authors.lastname: Briere
authors.forename: D
authors.initials: D
authors.lastname: Guyotat
authors.forename: P
authors.initials: P
authors.lastname: Casassus
authors.forename: B
authors.initials: B
authors.lastname: Audhuy
authors.forename: Z
authors.initials: Z
authors.lastname: Tellier
authors.forename: P
authors.initials: P
authors.lastname: Hurteloup
authors.forename: P
authors.initials: P
authors.lastname: Herve
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000627:therapeutic use; D003630:Daunorubicin / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D015255:Idarubicin / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012074:Remission Induction
chemical_list: D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; C002205:zorubicin; D015255:Idarubicin; D003630:Daunorubicin