title: Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission.
abstract: 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.
authors.affiliation: Northwestern University Medical School, Chicago, Illinois, USA.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bishop
authors.forename: Neal
authors.initials: N
authors.lastname: Christiansen
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Frankel
authors.forename: Juan J
authors.initials: JJ
authors.lastname: García
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Laughlin
authors.forename: Jane
authors.initials: J
authors.lastname: Liesveld
authors.forename: Charles
authors.initials: C
authors.lastname: Linker
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Selina
authors.initials: S
authors.lastname: Luger
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Milone
authors.forename: Santiago
authors.initials: S
authors.lastname: Pavlovsky
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.forename: James A
authors.initials: JA
authors.lastname: Russell
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Saez
authors.forename: Gary
authors.initials: G
authors.lastname: Schiller
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Roy S
authors.initials: RS
authors.lastname: Weiner
authors.forename: Axel R
authors.initials: AR
authors.lastname: Zander
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
mesh_terms: 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