title: 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.
abstract: 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.
authors.affiliation: University of Ulm, Ulm, Germany.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Schlenk
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Jürgen
authors.initials: J
authors.lastname: Krauter
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Edward A
authors.initials: EA
authors.lastname: Copelan
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Nimer
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
mesh_terms: 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