A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission.
Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOL-adjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.
Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan;
Saiko
S
Kurosawa
Takuhiro
T
Yamaguchi
Shuichi
S
Miyawaki
Naoyuki
N
Uchida
Heiwa
H
Kanamori
Kensuke
K
Usuki
Takuya
T
Yamashita
Masato
M
Watanabe
Kazuaki
K
Yakushiji
Shingo
S
Yano
Yuichiro
Y
Nawa
Jun
J
Taguchi
Jin
J
Takeuchi
Junji
J
Tomiyama
Yuko
Y
Nakamura
Ikuo
I
Miura
Yoshinobu
Y
Kanda
Yoichi
Y
Takaue
Takahiro
T
Fukuda
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011788:Quality of Life; D012074:Remission Induction; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
D000970:Antineoplastic Agents