HLA-identical sibling allogeneic transplants versus chemotherapy in acute myelogenous leukemia with t(8;21) in first complete remission: collaborative study between the German AML Intergroup and CIBMTR.
We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95% confidence interval [CI] 2.95-15.45, P < .001), lower relapse (RR 0.47, 95% CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 x 10(9)/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT.
Schlenk
Richard F
RF
University of Ulm, Ulm, Germany.
Pasquini
Marcelo C
MC
Pérez
Waleska S
WS
Zhang
Mei-Jie
MJ
Krauter
Jürgen
J
Antin
Joseph H
JH
Bashey
Asad
A
Bolwell
Brian J
BJ
Büchner
Thomas
T
Cahn
Jean-Yves
JY
Cairo
Mitchell S
MS
Copelan
Edward A
EA
Cutler
Corey S
CS
Döhner
Hartmut
H
Gale
Robert Peter
RP
Ilhan
Osman
O
Lazarus
Hillard M
HM
Liesveld
Jane L
JL
Litzow
Mark R
MR
Marks
David I
DI
Maziarz
Richard T
RT
McCarthy
Philip L
PL
Nimer
Stephen D
SD
Sierra
Jorge
J
Tallman
Martin S
MS
Weisdorf
Daniel J
DJ
Horowitz
Mary M
MM
Ganser
Arnold
A
D000293:Adolescent; D000328:Adult; D002891:Chromosomes, Human, Pair 21; D002898:Chromosomes, Human, Pair 8; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D035781:Siblings; D015996:Survival Rate; D014178:Translocation, Genetic; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome