Prospective evaluation of allogeneic hematopoietic stem-cell transplantation from matched related and matched unrelated donors in younger adults with high-risk acute myeloid leukemia: German-Austrian trial AMLHD98A.
OBJECTIVE
To assess the impact of allogeneic hematopoietic stem-cell transplantation (HSCT) from matched related donors (MRDs) and matched unrelated donors (MUDs) on outcome in high-risk patients with acute myeloid leukemia (AML) within a prospective multicenter treatment trial.


METHODS
Between 1998 and 2004, 844 patients (median age, 48 years; range, 16 to 62 years) with AML were enrolled onto protocol AMLHD98A that included a risk-adapted treatment strategy. High risk was defined by the presence of unfavorable cytogenetics and/or by no response to induction therapy.


RESULTS
Two hundred sixty-seven (32%) of 844 patients were assigned to the high-risk group. Of these 267 patients, 51 patients (19%) achieved complete remission but had adverse cytogenetics, and 216 patients (81%) had no response to induction therapy. Allogeneic HSCT was actually performed in 162 (61%) of 267 high-risk patients, after a median time of 147 days after diagnosis. Graft sources were as follows: MRD (n = 62), MUD (n = 89), haploidentical donor (n = 10), and cord blood (n = 1). The 5-year overall survival rates were 6.5% (95% CI, 3.1% to 13.6%) for patients (n = 105) not proceeding to HSCT and 25.1% (95% CI, 19.1% to 33.0%; from date of transplantation) for patients (n = 162) receiving HSCT. Multivariable analysis including allogeneic HSCT as a time-dependent covariable revealed that allogeneic HSCT significantly improved outcome; there was no difference in outcome between allogeneic HSCT from MRD and MUD.


CONCLUSIONS
Allogeneic HSCT in younger adults with high-risk AML has a significant beneficial impact on outcome, and allogeneic HSCT from MRD and MUD yields similar results.
Schlenk
Richard F
RF
Universitätsklinikum Ulm, Ulm, Germany. richard.schlenk@uniklinik-ulm.de
Döhner
Konstanze
K
Mack
Silja
S
Stoppel
Michael
M
Király
Franz
F
Götze
Katharina
K
Hartmann
Frank
F
Horst
Heinz A
HA
Koller
Elisabeth
E
Petzer
Andreas
A
Grimminger
Wolfgang
W
Kobbe
Guido
G
Glasmacher
Axel
A
Salwender
Hans
H
Kirchen
Heinz
H
Haase
Detlef
D
Kremers
Stephan
S
Matzdorff
Axel
A
Benner
Axel
A
Döhner
Hartmut
H
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001317:Austria; D017024:Chemotherapy, Adjuvant; D020732:Cytogenetic Analysis; D005858:Germany; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010375:Pedigree; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult