Early matched sibling hematopoietic cell transplantation for adult AML in first remission using an age-adapted strategy: long-term results of a prospective GOELAMS study.
The LAM2001 phase 3 trial, involving 832 patients with acute myeloid leukemia (AML; median: 46 years) proposed HLA-identical sibling allograft HSCT for all patients with an identified donor. The trial compared reduced-intensity conditioning (RIC) for patients older than 50 years of age (N = 47) and myeloablative conditioning for younger patients (N = 117). BM HSCT was performed in the younger patients, while the older ones received a consolidation course, followed by peripheral blood allo-HSCT using RIC. The incidence of grade II-IV acute GVHD, was 51.9% (95% confidence interval [CI]: 42.1-61.8) and 11.3% (1.6-21.2) after myeloablative or RIC, respectively (P < .0001) and that of chronic GVHD 45.8% (95% CI: 34.8-56.7) and 41.7% (24.7-58.6; NS). Cumulative incidence of nonrelapse mortality at 108 months was 15.8% (95% CI: 9.8-23.2) for myeloablative, and 6.5% (0.2-16.2) for RIC (NS). CI of relapse at 108 months was 21.7% (95% CI: 13.9-28.6) and 28.6% (16.5-43.4; NS). Overall survival at 108 months was 63.4% (95% CI: 54.6-72.2) and 65.8% (52.2-72.2), respectively, after myeloablative or RIC (NS). RIC peripheral blood stem cell allo-HSCT is prospectively feasible for patients between the ages of 51 and 60 years without excess of relapse or nonrelapse mortality, and compares favorably with myeloablative marrow allo-HSCT proposed to younger patients.
Department of Hematology, CHU, Strasbourg, France.
Bruno
B
Lioure
Marie C
MC
Béné
Arnaud
A
Pigneux
Anne
A
Huynh
Patrice
P
Chevallier
Nathalie
N
Fegueux
Didier
D
Blaise
Brigitte
B
Witz
Martine
M
Delain
Jérôme
J
Cornillon
Isabelle
I
Luquet
Odile
O
Blanchet
Pascale
P
Cornillet-Lefebvre
Martin
M
Carré
Mathilde
M
Hunault
Fabrice
F
Larosa
Thierry
T
Lamy
Edouard
E
Randriamalala
Mario
M
Ojeda-Uribe
Christian
C
Berthou
Luc
L
Fornecker
Jean-Luc
JL
Harousseau
Didier
D
Bouscary
Norbert
N
Ifrah
Jean-Yves
JY
Cahn
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016016:Proportional Hazards Models; D012074:Remission Induction; D035781:Siblings; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality