title: Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40-60 years.
abstract: The preferred type of post-remission therapy (PRT) in patients with acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate, especially in patients at higher risk of nonrelapse mortality (NRM), including patients >40 years of age. We report results of a time-dependent multivariable analysis of allogenic hematopoietic stem cell transplantation (alloHSCT) (n=337) versus chemotherapy (n=271) or autologous HSCT (autoHSCT) (n=152) in 760 patients aged 40-60 years with AML in CR1. Patients receiving alloHSCT showed improved overall survival (OS) as compared with chemotherapy (respectively, 57±3% vs 40±3% at 5 years, P<0.001). Comparable OS was observed following alloHSCT and autoHSCT in patients with intermediate-risk AML (60±4 vs 54±5%). However, alloHSCT was associated with less relapse (hazard ratio (HR) 0.51, P<0.001) and better relapse-free survival (RFS) (HR 0.74, P=0.029) as compared with autoHSCT in intermediate-risk AMLs. AlloHSCT was applied following myeloablative conditioning (n=157) or reduced intensity conditioning (n=180), resulting in less NRM, but comparable outcome with respect to OS, RFS and relapse. Collectively, these results show that alloHSCT is to be preferred over chemotherapy as PRT in patients with intermediate- and poor-risk AML aged 40-60 years, whereas autoHSCT remains a treatment option to be considered in patients with intermediate-risk AML.
authors.affiliation: Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Versluis
authors.affiliation: Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland.
authors.forename: J R
authors.initials: JR
authors.lastname: Passweg
authors.affiliation: HOVON Data Center and Department of Trials and Statistics, Rotterdam, The Netherlands.
authors.forename: W L J
authors.initials: WL
authors.lastname: van Putten
authors.affiliation: Division of Hematology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: M G
authors.initials: MG
authors.lastname: Manz
authors.affiliation: Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Maertens
authors.affiliation: Department of Clinical Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: H B
authors.initials: HB
authors.lastname: Beverloo
authors.affiliation: Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: P J M
authors.initials: PJ
authors.lastname: Valk
authors.affiliation: Department of Internal medicine, Isala Hospital, Zwolle, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Marwijk Kooy
authors.affiliation: Department of Hematology, Haga Hospital, The Hague, The Netherlands.
authors.forename: P W
authors.initials: PW
authors.lastname: Wijermans
authors.affiliation: Department of Hematology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Schaafsma
authors.affiliation: Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: B J
authors.initials: BJ
authors.lastname: Biemond
authors.affiliation: Department of Hematology, Hôpital St Luc, Brussels, Belgium.
authors.forename: M-C
authors.initials: MC
authors.lastname: Vekemans
authors.affiliation: Department of Hematology, Stuivenberg Hospital, Antwerp, Belgium.
authors.forename: D A
authors.initials: DA
authors.lastname: Breems
authors.affiliation: Departments of Immunology and Hematology, University Medical Center, Utrecht, The Netherlands.
authors.forename: L F
authors.initials: LF
authors.lastname: Verdonck
authors.affiliation: Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: M F
authors.initials: MF
authors.lastname: Fey
authors.affiliation: Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Jongen-Lavrencic
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J J W M
authors.initials: JJ
authors.lastname: Janssen
authors.affiliation: Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Huls
authors.affiliation: Departments of Immunology and Hematology, University Medical Center, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kuball
authors.affiliation: Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Pabst
authors.affiliation: Department of Hematology, Mont-Godinne, Yvoir, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Graux
authors.affiliation: Department of Hematology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.affiliation: Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Vellenga
authors.affiliation: Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Ossenkoppele
authors.affiliation: Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Löwenberg
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000737:chemistry; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012074:Remission Induction; D012306:Risk; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents