title: Comparison of reduced-intensity hematopoietic cell transplantation with chemotherapy in patients age 60-70 years with acute myelogenous leukemia in first remission.
abstract: We compared the outcomes of patients age 60-70 years with acute myelogenous leukemia receiving reduced-intensity allogeneic hematopoietic cell transplantation (HCT) in first remission (CR1) reported to the Center for International Blood and Marrow Research (n = 94) with the outcomes in patients treated with induction and postremission chemotherapy on Cancer and Leukemia Group B protocols (n = 96). All patients included had been in CR1 for at least 4 months. The HCT recipients were slightly younger than the chemotherapy patients (median age, 63 years vs 65 years; P < .001), but there were no significant between-group differences in the proportion with therapy-related leukemia or in different cytogenetic risk groups. Time from diagnosis to CR1 was longer for the HCT recipients (median, 44 days vs 38 days; P = .031). Allogeneic HCT was associated with significantly lower risk of relapse (32% vs 81% at 3 years; P < .001), higher nonrelapse mortality (36% vs 4% at 3 years; P < .001), and longer leukemia-free survival (32% vs 15% at 3 years; P = .001). Although overall survival was longer for HCT recipients, the difference was not statistically significant (37% vs 25% at 3 years; P = .08). Our findings suggest that reduced-intensity conditioning allogeneic HCT in patients age 60-70 with acute myelogenous leukemia in CR1 reduces relapse and improves leukemia-free survival. Strategies that reduce nonrelapse mortality may yield significant improvements in overall survival.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ssfarag@iupui.edu
authors.forename: Sherif S
authors.initials: SS
authors.lastname: Farag
authors.forename: Kati
authors.initials: K
authors.lastname: Maharry
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Stephen L
authors.initials: SL
authors.lastname: George
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mrózek
authors.forename: John
authors.initials: J
authors.lastname: DiPersio
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bunjes
authors.forename: Guido
authors.initials: G
authors.lastname: Marcucci
authors.forename: Maria R
authors.initials: MR
authors.lastname: Baer
authors.forename: Mitchell
authors.initials: M
authors.lastname: Cairo
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Robert
authors.initials: R
authors.lastname: Soiffer
authors.forename: Richard A
authors.initials: RA
authors.lastname: Larson
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Clara D
authors.initials: CD
authors.lastname: Bloomfield
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome