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.
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.
Jourdan
Eric
E
Département d'Hématologie, Hôpital Caremeau, Centre Hospitalier Universitaire (CHU), Nîmes, France.
Boiron
Jean-Michel
JM
Dastugue
Nicole
N
Vey
Norbert
N
Marit
Gérald
G
Rigal-Huguet
Françoise
F
Molina
Lysiane
L
Fegueux
Nathalie
N
Pigneux
Arnaud
A
Recher
Christian
C
Rossi
Jean-François
JF
Attal
Michel
M
Sotto
Jean-Jacques
JJ
Maraninchi
Dominique
D
Reiffers
Josy
J
Bardou
Valerie-Jeanne
VJ
Esterni
Benjamin
B
Blaise
Didier
D
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