title: Impact of postremission consolidation chemotherapy on outcome after reduced-intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia in first complete remission: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
abstract: BACKGROUND
  The objective of the current study was to investigate the role of postremission consolidation chemotherapy before reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (alloSCT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1).
  
  
  METHODS
  Of the 789 consecutive patients with AML in CR1 who underwent RIC alloSCT from a human leukocyte antigen-matched sibling or matched unrelated donor peripheral stem cell grafts between 2001 and 2010, 591 patients received at least 1 cycle of consolidation chemotherapy and 198 patients did not receive any consolidation chemotherapy before alloSCT. To minimize inherent survival bias in favor of patients who underwent transplant long after achieving CR1, the study focused on 373 patients who underwent transplant within the median time frame between achievement of CR1 and alloSCT (3 months for patients who underwent alloSCT from matched siblings and 4 months for patients who underwent alloSCT from matched unrelated donors). In this subgroup, 151 patients did not receive any consolidation chemotherapy and 222 patients received ≥ 1 consolidation chemotherapy cycle.
  
  
  RESULTS
  With a median follow-up of 36 months (range, 2 months-135 months), the 3-year cumulative recurrence incidence (RI) was not significantly different between the groups (36% ± 4% for the group treated without consolidation chemotherapy vs 38% ± 3% for patients who received consolidation chemotherapy; P = .89). In addition, leukemia-free survival was similar between the groups (45% ± 4% and 47% ± 3%, respectively; P = .41). Dose intensity of cytarabine given during consolidation chemotherapy appeared to have no influence on RI. On multivariate analysis, pretransplant consolidation (≥ 1 cycle vs 0 cycles) was found to have no significant impact on RI (hazards ratio, 1.29; 95% confidence interval, 0.84-1.97 [P = .24]) or leukemia-free survival (hazards ratio, 1.00; 95% confidence interval, 0.71-1.42 [P = .99]).
  
  
  CONCLUSIONS
  The data from the current study suggest no apparent advantage for postremission consolidation chemotherapy before RIC alloSCT, provided a donor is readily available.
authors: Bone Marrow Transplantation Unit, Institute of Hematology, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Moshe
authors: M
authors: Yeshurun
authors: Myriam
authors: M
authors: Labopin
authors: Didier
authors: D
authors: Blaise
authors: Jan J
authors: JJ
authors: Cornelissen
authors: Henrik
authors: H
authors: Sengeloev
authors: Lars
authors: L
authors: Vindelov
authors: Juergen
authors: J
authors: Kuball
authors: Patrice
authors: P
authors: Chevallier
authors: Charles
authors: C
authors: Craddock
authors: Gerard
authors: G
authors: Socie
authors: Karin
authors: K
authors: Bilger
authors: Harry C
authors: HC
authors: Schouten
authors: Nathalie
authors: N
authors: Fegueux
authors: Hakan
authors: H
authors: Goker
authors: Johan
authors: J
authors: Maertens
authors: Donald
authors: D
authors: Bunjes
authors: Renate
authors: R
authors: Arnold
authors: Arnon
authors: A
authors: Nagler
authors: Mohamad
authors: M
authors: Mohty
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D060830:Consolidation Chemotherapy / Q000379:methods*; D003561:Cytarabine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D007166:Immunosuppressive Agents; D003561:Cytarabine
keywords: acute myeloid leukemia; allogeneic stem cell transplantation (alloSCT); complete remission; consolidation; reduced-intensity conditioning