title: Allogeneic transplantation versus chemotherapy as postremission therapy for acute myeloid leukemia: a prospective matched pairs analysis.
abstract: OBJECTIVE
  The majority of patients with acute myeloid leukemia (AML) who achieve complete remission (CR) relapse with conventional postremission chemotherapy. Allogeneic stem-cell transplantation (alloSCT) might improve survival at the expense of increased toxicity. It remains unknown for which patients alloSCT is preferable.
  
  
  METHODS
  We compared the outcome of 185 matched pairs of a large multicenter clinical trial (AMLCG99). Patients younger than 60 years who underwent alloSCT in first remission (CR1) were matched to patients who received conventional postremission therapy. The main matching criteria were AML type, cytogenetic risk group, patient age, and time in first CR.
  
  
  RESULTS
  In the overall pairwise compared AML population, the projected 7-year overall survival (OS) rate was 58% for the alloSCT and 46% for the conventional postremission treatment group (P = .037; log-rank test). Relapse-free survival (RFS) was 52% in the alloSCT group compared with 33% in the control group (P < .001). OS was significantly better for alloSCT in patient subgroups with nonfavorable chromosomal aberrations, patients older than 45 years, and patients with secondary AML or high-risk myelodysplastic syndrome. For the entire patient cohort, postremission therapy was an independent factor for OS (hazard ratio, 0.66; 95% CI, 0.49 to 0.89 for alloSCT v conventional chemotherapy), among age, cytogenetics, and bone marrow blasts after the first induction cycle.
  
  
  CONCLUSIONS
  AlloSCT is the most potent postremission therapy for AML and is particularly active for patients 45 to 59 years of age and/or those with high-risk cytogenetics.
authors.affiliation: Matthias Stelljes, Utz Krug, Maria C. Sauerland, Achim Heinecke, Sandra Ligges, Tim Sauer, Petra Tschanter, Gabriela B. Thoennissen, Björna Berning, Carsten Müller-Tidow, Wolfgang E. Berdel, and Thomas Büchner, University Hospital of Muenster, Muenster; Dietrich W. Beelen, University Hospital of Essen, Essen; Jan Braess, Krankenhaus Barmherzige Brüder; Albrecht Reichle, Ernst Holler, University of Regensburg, Regensburg; Hans J. Kolb, Wolfgang Hiddeman, University of Munich-Grosshadern, Munich; Rainer Schwerdtfeger, Deutsche Klinik für Diagnostik, Wiesbaden; Renate Arnold, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum; Bernhard J. Woermann, German Society of Hematology and Oncology, Berlin; and Christoph Scheid, University of Cologne, Cologne, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelljes
authors.forename: Utz
authors.initials: U
authors.lastname: Krug
authors.forename: Dietrich W
authors.initials: DW
authors.lastname: Beelen
authors.forename: Jan
authors.initials: J
authors.lastname: Braess
authors.forename: Maria C
authors.initials: MC
authors.lastname: Sauerland
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Sandra
authors.initials: S
authors.lastname: Ligges
authors.forename: Tim
authors.initials: T
authors.lastname: Sauer
authors.forename: Petra
authors.initials: P
authors.lastname: Tschanter
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Thoennissen
authors.forename: Björna
authors.initials: B
authors.lastname: Berning
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Albrecht
authors.initials: A
authors.lastname: Reichle
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
authors.forename: Christoph
authors.initials: C
authors.lastname: Scheid
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller-Tidow
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Woermann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D014184:Transplantation, Homologous; D016896:Treatment Outcome