title: The superiority of haploidentical related stem cell transplantation over chemotherapy alone as postremission treatment for patients with intermediate- or high-risk acute myeloid leukemia in first complete remission.
abstract: We report the results of a prospective, patient self-selected study evaluating whether haploidentical related donor stem cell transplantation (HRD-HSCT) is superior to chemotherapy alone as postremission treatment for patients with intermediate- or high-risk acute myeloid leukemia (AML) in first complete remission (CR1). Among totally 419 newly diagnosed AML patients, 132 patients with intermediate- and high-risk cytogenetics achieved CR1 and received chemotherapy alone (n = 74) or HSCT (n = 58) as postremission treatment. The cumulative incidence of relapse at 4 years was 37.5% ± 4.5%. Overall survival (OS) and disease-free survival (DFS) at 4 years were 64.5% ± 5.1% and 55.6% ± 5.0%, respectively. The cumulative incident of relapse for the HRD-HSCT group was significantly lower than that for the chemotherapy-alone group (12.0% ± 4.6% vs 57.8% ± 6.2%, respectively; P < .0001). HRD-HSCT resulted in superior survival compared with chemotherapy alone (4-year DFS, 73.1% ± 7.1% vs 44.2% ± 6.2%, respectively; P < .0001; 4-year OS, 77.5% ± 7.1% vs 54.7% ± 6.3%, respectively; P = .001). Multivariate analysis revealed postremission treatment (HRD-HSCT vs chemotherapy) and high WBC counts at diagnosis as independent risk factors affecting relapse, DFS, and OS. Our results suggest that HRD-HSCT is superior to chemotherapy alone as postremission treatment for AML.
authors.affiliation: Beijing Key Laboratory of Hematopoletic Stem Cell Transplantation, Peking University People's Hospital and Peking University Institute of Hematology, Beijing, China. xjhrm@medmail.com.cn
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
authors.forename: Hong-Hu
authors.initials: HH
authors.lastname: Zhu
authors.forename: Ying-Jun
authors.initials: YJ
authors.lastname: Chang
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Dai-Hong
authors.initials: DH
authors.lastname: Liu
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.forename: Qian
authors.initials: Q
authors.lastname: Jiang
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D020732:Cytogenetic Analysis; D018572:Disease-Free Survival; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D006680:HLA Antigens