title: Allogeneic transplantation as post-remission therapy for cytogenetically high-risk acute myeloid leukemia: landmark analysis from a single prospective multicenter trial.
abstract: Background Allogeneic hematopoietic cell transplantation is considered the preferred post-remission therapy in patients with acute myeloid leukemia cytogenetically defined as being at high risk. To substantiate evidence for allogeneic hematopoietic cell transplantation in first complete remission in these high-risk patients we performed a landmark analysis within a single prospective multicenter treatment trial.
  
  
  METHODS
  By the time of analysis, 2,347 patients had been accrued into the AMLCG 99 trial between 1999 - 2007. Out of this population, 243 patients under 60 years old fulfilled the criteria for high-risk cytogenetics. Landmark analyses were performed with a control cohort, who remained in first complete remission at least the median time from complete remission to transplantation in the intervention group.
  
  
  RESULTS
  After standardized induction therapy, 111 patients under 60 years old achieved complete remission. A matched allogeneic donor was identified for 59 patients (30 sibling donors, 29 unrelated donors). Fifty-five patients received an allogeneic hematopoietic cell transplant after a median time of 88 days in first complete remission. Of the remaining 56 patients, 21 relapsed within 90 days after achieving first complete remission and for 7 patients with relevant comorbidities no donors search was initiated, leaving 28 patients given conventional post-remission therapy as the control cohort. The median follow-up of surviving patients was 60.4 months. Patients with an allogeneic donor had substantially better 5-year overall and relapse-free survival rates than the control group (48% versus 18%, P=0.004 and 39% versus 10%, P<0.001, respectively). A survival benefit from transplantation was evident regardless of donor type, age and monosomal karyotype. Conclusions Beyond evidence available for subgroups of high-risk patients, the findings of this study establish in a broader manner that allogeneic hematopoietic cell transplantation is a preferable consolidation treatment for patients with acute myeloid leukemia and high-risk cytogenetics. The study was registered at Clinicaltrials.gov as NCT00266136.
authors: Department of Medicine A/Hematology and Oncology, University of Muenster, Albert-Schweitzer-Str. 33, D-48129 Muenster, Germany. stell-jes@uni-muenster.de
authors: Matthias
authors: M
authors: Stelljes
authors: Dietrich W
authors: DW
authors: Beelen
authors: Jan
authors: J
authors: Braess
authors: Maria C
authors: MC
authors: Sauerland
authors: Achim
authors: A
authors: Heinecke
authors: Björna
authors: B
authors: Berning
authors: Hans J
authors: HJ
authors: Kolb
authors: Ernst
authors: E
authors: Holler
authors: Rainer
authors: R
authors: Schwerdtfeger
authors: Renate
authors: R
authors: Arnold
authors: Karsten
authors: K
authors: Spiekermann
authors: Carsten
authors: C
authors: Müller-Tidow
authors: Hubert L
authors: HL
authors: Serve
authors: Gerda
authors: G
authors: Silling
authors: Wolfgang
authors: W
authors: Hiddemann
authors: Wolfgang E
authors: WE
authors: Berdel
authors: Thomas
authors: T
authors: Büchner
authors: Joachim
authors: J
authors: Kienast
mesh_terms: D000328:Adult; D003582:Cytogenetics; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009006:Monosomy / Q000235:genetics; D020360:Neoadjuvant Therapy; D012008:Recurrence; D012074:Remission Induction; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult