title: Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research.
abstract: The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.
authors.affiliation: Princess Margaret Hospital, University of Toronto, Ontario, Canada.
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
authors.forename: Gisela
authors.initials: G
authors.lastname: DaSilva
authors.forename: Waleska S
authors.initials: WS
authors.lastname: Pérez
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: James L
authors.initials: JL
authors.lastname: Gajewski
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Michael
authors.initials: M
authors.lastname: Lill
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Chadi
authors.initials: C
authors.lastname: Nabhan
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Schiller
authors.forename: Gerald
authors.initials: G
authors.lastname: Socie
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: D000328:Adult; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D035781:Siblings; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens