title: Comparison of autologous hematopoietic cell transplantation and chemotherapy as postremission treatment in non-M3 acute myeloid leukemia in first complete remission.
abstract: Randomized trials of acute myeloid leukemia (AML) in first complete remission (CR1) showed that autologous hematopoietic cell transplantation (auto-HCT) improves relapse-free survival (RFS) but not overall survival (OS), compared with chemotherapy. Using a database of 2518 adult patients with AML in CR1, we conducted a 5-month landmark analysis and found that auto-HCT improves 3-year RFS but not OS compared with chemotherapy.
  
  
  BACKGROUND
  A number of randomized trials in patients with AML in CR1 have been conducted and they showed that auto-HCT improves RFS but not OS, compared with chemotherapy. However, because these trials have had compliance problems, the value of auto-HCT still has not been clearly established.
  
  
  METHODS
  Using a database of 2518 adult patients with AML in CR1, we retrospectively analyzed the outcome of auto-HCT and compared it with intensive nonmyeloablative chemotherapy using landmark analyses.
  
  
  RESULTS
  In 103 auto-HCT recipients, OS and RFS at 3 years from treatment were 65% and 57%, respectively. Multivariate analysis showed that unfavorable risk cytogenetics and entry into CR1 after 2 courses of induction treatment predicted a poor outcome. Because the median time interval between CR1 and auto-HCT was 153 days, landmark analyses at 5 months after CR1 were performed to compare 1290 patients who received chemotherapy alone (median age, 52 years; range, 16-70) with 103 who received auto-HCT (median age, 48 years; range, 16-67). Auto-HCT improves 3-year RFS (58% vs. 37%; P < .001) but not OS compared with chemotherapy alone. Among patients with unfavorable risk cytogenetics or those who required 2 courses to reach CR1, there was no significant difference in RFS between the 2 groups.
  
  
  CONCLUSIONS
  Auto-HCT can be considered as a postremission therapy for AML patients with favorable or intermediate risk cytogenetics who achieve CR1 after a single course of induction treatment.
authors.affiliation: Division of Hematology, NTT Kanto Medical Center, Tokyo, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Usuki
authors.forename: Saiko
authors.initials: S
authors.lastname: Kurosawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yakushiji
authors.forename: Fusako
authors.initials: F
authors.lastname: Waki
authors.forename: Eijo
authors.initials: E
authors.lastname: Matsuishi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kagawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.forename: Manabu
authors.initials: M
authors.lastname: Shimoyama
authors.forename: Hiroatsu
authors.initials: H
authors.lastname: Ago
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Yamano
authors.forename: Shingo
authors.initials: S
authors.lastname: Yano
authors.forename: Naohito
authors.initials: N
authors.lastname: Fujishima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takamatsu
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hidaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000601:surgery*; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult