Frequency of allogeneic hematopoietic cell transplantation among patients with high- or intermediate-risk acute myeloid leukemia in first complete remission.
OBJECTIVE
To determine the frequency of allogeneic hematopoietic cell transplantation (HCT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1).


METHODS
Between January 1, 2008, and March 1, 2011, 212 newly diagnosed patients with AML received treatment at our center. Ninety-five patients age less than 75 years with intermediate- or high-risk AML achieved a complete remission, and 21 patients achieved a morphologic remission with incomplete blood count recovery.


RESULTS
Seventy-eight (67%; 95% CI, 58% to 76%) of 116 patients received HCT at a median of 2.8 months (range, 0.5 to 19 months) from their CR1 date. The median age was 57 years in both the HCT patient group (range, 18 to 75 years) and the non-HCT patient group (range, 24 to 70 years; P = .514). Between the HCT patients and the non-HCT patients, the mean Eastern Cooperative Oncology Group performance status was 1.1 compared with 1.5, respectively (P = .005), and the average HCT comorbidity score within 60 days of CR1 was 1.7 and 2.1, respectively (P = .68). Twenty-nine (76%) of 38 non-HCT patients were HLA typed, and matched donors were found for 13 of these 29 patients (34% of all non-HCT patients). The most common causes for patients not receiving transplantation in CR1 were early relapse (within 6 months) in 12 patients (32%), poor performance status in eight patients (21%), and physician decision in five patients (13%).


CONCLUSIONS
HCT can be performed in CR1 in the majority of patients with AML for whom it is currently recommended. The main barriers to HCT were early relapse and poor performance status, highlighting the need for improved therapies for patients with AML of all ages.
Raya Mawad, Ted A. Gooley, Vicky Sandhu, Bart Scott, Brenda M. Sandmaier, Paul O'Donnell, Pamela S. Becker, Stephen Petersdorf, Kathleen Shannon Dorcy, Paul Hendrie, Mohamed L. Sorror, Roland B. Walter, H. Joachim Deeg, Frederick R. Appelbaum, Elihu H. Estey, and John M. Pagel, Fred Hutchinson Cancer Research Center; Raya Mawad, Bart Scott, Brenda M. Sandmaier, Paul O'Donnell, Pamela S. Becker, Stephen Petersdorf, Paul Hendrie, Mohamed L. Sorror, Roland B. Walter, H. Joachim Deeg, Frederick R. Appelbaum, Elihu H. Estey, and John M. Pagel, University of Washington, Seattle, WA; and Jack Lionberger, St Louis University, St Louis, MO.
Raya
R
Mawad
Ted A
TA
Gooley
Vicky
V
Sandhu
Jack
J
Lionberger
Bart
B
Scott
Brenda M
BM
Sandmaier
Paul
P
O'Donnell
Pamela S
PS
Becker
Stephen
S
Petersdorf
Kathleen Shannon
KS
Dorcy
Paul
P
Hendrie
Mohamed L
ML
Sorror
Roland B
RB
Walter
H Joachim
HJ
Deeg
Frederick R
FR
Appelbaum
Elihu H
EH
Estey
John M
JM
Pagel
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012074:Remission Induction; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000401:mortality / Q000706:statistics & numerical data; D055815:Young Adult