title: Early related or unrelated haematopoietic cell transplantation results in higher overall survival and leukaemia-free survival compared with conventional chemotherapy in high-risk acute myeloid leukaemia patients in first complete remission.
abstract: Between 1996 and 2004, a total of 708 patients were enrolled in the acute myeloid leukaemia (AML) '96 and '02 studies of the East German Study Group (OSHO). Of these, 138 patients (19.5%) had unfavourable cytogenetics defined as complex karyotype, del (5q)/-5, del (7q)/-7, abn (3q26) and abn (11q23). In all, 77 (56%) achieved complete remission 1 (CR1) after induction chemotherapy and were eligible for haematopoietic cell transplantation (HCT). HCT was performed after a median of two cycles of consolidation chemotherapy (CT) in the AML '96 and one cycle in the AML '02 study (P=0.03). After a median follow-up of 19 months, overall survival (OS) at two years was significantly better in the donor group (52+/-9%) versus the no-donor group (24+/-8%; P=0.005). Differences in outcomes were mainly because of a lower relapse incidence in patients after HCT (39+/-11%) compared with a higher relapse incidence in patients undergoing CT (77+/-10%; P=0.0005). Treatment-related mortality was low and not statistically significantly different between the two treatment groups (15+/-7 and 5+/-5% for HCT and chemotherapy, respectively; P=0.49).We conclude that early HCT from related or unrelated donors led to significantly better OS and leukaemia-free survival compared with chemotherapy in patients with unfavourable karyotype.
authors.affiliation: Department of Hematology and Oncology, University Medical School, Leipzig, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Basara
authors.forename: A
authors.initials: A
authors.lastname: Schulze
authors.forename: U
authors.initials: U
authors.lastname: Wedding
authors.forename: M
authors.initials: M
authors.lastname: Mohren
authors.forename: A
authors.initials: A
authors.lastname: Gerhardt
authors.forename: C
authors.initials: C
authors.lastname: Junghanss
authors.forename: N
authors.initials: N
authors.lastname: Peter
authors.forename: G
authors.initials: G
authors.lastname: Dölken
authors.forename: C
authors.initials: C
authors.lastname: Becker
authors.forename: S
authors.initials: S
authors.lastname: Heyn
authors.forename: C
authors.initials: C
authors.lastname: Kliem
authors.forename: T
authors.initials: T
authors.lastname: Lange
authors.forename: R
authors.initials: R
authors.lastname: Krahl
authors.forename: W
authors.initials: W
authors.lastname: Pönisch
authors.forename: H-J
authors.initials: HJ
authors.lastname: Fricke
authors.forename: H G
authors.initials: HG
authors.lastname: Sayer
authors.forename: H
authors.initials: H
authors.lastname: Al-Ali
authors.forename: F
authors.initials: F
authors.lastname: Kamprad
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult