Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission.
Controversy exists over whether pretransplantation consolidation chemotherapy affects the outcome of subsequent autotransplantation for acute myelogenous leukemia (AML). The current study was undertaken to determine the association between previous consolidation and outcome of autotransplantation for AML in first remission. Posttransplantation outcomes of 146 patients receiving no consolidation were compared with those of 244 patients receiving standard-dose (<1 gm/m(2)) and 249 patients receiving high-dose (1-3 gm/m(2)) cytarabine, using proportional hazards regression to adjust for differences in prognostic variables. One-year transplantation-related mortality was similar among the cohorts. Five-year relapse rates were 49% (95% confidence interval CI} = 39%-58%) with no consolidation, 35% (95% CI = 29%-42%) with standard-dose cytarabine, and 40% (95% CI = 33%-48%) with high-dose cytarabine (P = .07). Five-year leukemia-free survival rates were 39% (95% CI = 30%-47%) with no consolidation, 53% (95% CI = 46%-60%) with standard-dose cytarabine, and 48% (95% CI = 40%-56%) with high-dose cytarabine (P = .03). Similarly, 5-year overall survival was better in those patients receiving consolidation: 42% (95% CI = 34%-51%) with no consolidation, 59% (95% CI = 52%-65%) with standard-dose cytarabine, and 54% (95% CI = 46%-61%) with high-dose cytarabine (P = .01). Although most patients received 1 or 2 cycles of consolidation, the number of courses had no detectable effect on transplantation outcome. In multivariate analysis, risks of relapse and treatment failure were lower in the patients receiving consolidation, especially among those patients receiving blood cell grafts. Outcomes with standard-dose and high-dose cytarabine were similar. Based on our findings, we recommend that patients with AML in first remission receive consolidation before undergoing autotransplantation.
Tallman
Martin S
MS
Northwestern University Medical School, Chicago, Illinois, USA.
Pérez
Waleska S
WS
Lazarus
Hillard M
HM
Gale
Robert Peter
RP
Maziarz
Richard T
RT
Rowe
Jacob M
JM
Marks
David I
DI
Cahn
Jean-Yves
JY
Bashey
Asad
A
Bishop
Michael R
MR
Christiansen
Neal
N
Frankel
Stanley R
SR
García
Juan J
JJ
Ilhan
Osman
O
Laughlin
Mary J
MJ
Liesveld
Jane
J
Linker
Charles
C
Litzow
Mark R
MR
Luger
Selina
S
McCarthy
Philip L
PL
Milone
Gustavo A
GA
Pavlovsky
Santiago
S
Phillips
Gordon L
GL
Russell
James A
JA
Saez
Ruben A
RA
Schiller
Gary
G
Sierra
Jorge
J
Weiner
Roy S
RS
Zander
Axel R
AR
Zhang
Mei-Jie
MJ
Keating
Armand
A
Weisdorf
Daniel J
DJ
Horowitz
Mary M
MM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous