title: Early allogeneic stem-cell transplantation for young adults with acute myeloblastic leukemia in first complete remission: an intent-to-treat long-term analysis of the BGMT experience.
abstract: OBJECTIVE
  We analyzed the impact of allogeneic stem-cell transplantation (alloSCT) as an early consolidation for young patients with acute myeloblastic leukemia in first complete remission (CR1) through four successive protocols.
  
  
  METHODS
  Of the 472 patients who achieved CR1, 182 (38%) had an HLA-identical sibling (donor group), and alloSCT was performed in 171 patients (94%). Of the 290 patients without donor (no-donor group), 62% received an autologous SCT.
  
  
  RESULTS
  In an intent-to-treat analysis based on donor availability, the overall 10-year survival probability was 51% v 43% (P = .11) for the donor and no-donor groups, respectively. A Cox analysis determined that four factors had independent prognostic significance for survival (initial WBC count, French-American-British subtypes, cytogenetic risk, and number of induction courses). This permitted constitution of a simple index that reclassified 21% of the patients compared with usual cytogenetic classification and identified three subpopulations with different outcome and different impact of alloSCT.
  
  
  CONCLUSIONS
  AlloSCT was associated with a survival advantage for an intermediate-risk group. In other groups, numbers are limited for definitive conclusion. However, early performed alloSCT does not seem to be the optimal treatment of high-risk patients or offer any advantage over intensive chemotherapy in low-risk patients.
authors.affiliation: Département d'Hématologie, Hôpital Caremeau, Centre Hospitalier Universitaire (CHU), Nîmes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Jourdan
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Nicole
authors.initials: N
authors.lastname: Dastugue
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.forename: Gérald
authors.initials: G
authors.lastname: Marit
authors.forename: Françoise
authors.initials: F
authors.lastname: Rigal-Huguet
authors.forename: Lysiane
authors.initials: L
authors.lastname: Molina
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.forename: Christian
authors.initials: C
authors.lastname: Recher
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Rossi
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Sotto
authors.forename: Dominique
authors.initials: D
authors.lastname: Maraninchi
authors.forename: Josy
authors.initials: J
authors.lastname: Reiffers
authors.forename: Valerie-Jeanne
authors.initials: VJ
authors.lastname: Bardou
authors.forename: Benjamin
authors.initials: B
authors.lastname: Esterni
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome