title: Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission.
abstract: Patients with acute myeloid leukemia (AML) without complete remission (CR) or in first relapse (Rel1) can have extended leukemia control and survival after allogeneic hematopoietic cell transplantation (HCT). For patients in Rel1 or primary induction failure (PIF), transplantation versus treatment to achieve a second CR (CR2) and subsequent HCT might yield similar outcomes, but available comparative data are scarce.
  
  
  
  Survival was analyzed in 4682 HCT recipients according to disease status: PIF (N = 1440), Rel1 (failing ≥1 reinduction; N = 1256), and CR2 (N = 1986).
  
  
  
  Patient, disease, and transplantation characteristics were similar, except that patients in CR2 more often had performance scores of 90% to 100%, de novo AML, and longer CR1 duration. Adverse cytogenetics were more common in patients who experienced PIF. The 5-year survival rate adjusted for performance score, cytogenetic risk, and donor type for CR2 was 39% (95% confidence interval [CI], 37%-41%) compared with 18% (95% CI, 16%-20%) for HCT in Rel1 and 21% (95% CI, 19%-23%) in PIF (P < .0001).
  
  
  
  Although survival is superior for patients who undergo HCT in CR2, transplantation for selected patients in Rel1 or PIF may still be valuable. These data can guide decision making about additional salvage therapy versus prompt HCT for patients not in CR, but they also highlight that AML is intrinsically more treatable in patients who have favorable-risk cytogenetics, those with longer CR1 duration, and younger patients with better performance status. Cancer 2017;123:2025-2034. © 2017 American Cancer Society.
authors.affiliation: Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Millard
authors.affiliation: Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: Sunesis Pharmaceuticals, San Francisco, California.
authors.forename: Parvinder S
authors.initials: PS
authors.lastname: Hyare
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.affiliation: Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ho
authors.affiliation: Adult Blood and Marrow Transplant Program, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Marco
authors.initials: M
authors.lastname: Mielcarek
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford Health Care, Stanford, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rezvani
authors.affiliation: Division of Hematology/Oncology, Barnes Jewish Hospital, St. Louis, Missouri.
authors.forename: Keith
authors.initials: K
authors.lastname: Stockerl-Goldstein
authors.affiliation: Hematology/Oncology, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia.
authors.forename: Hanna J
authors.initials: HJ
authors.lastname: Khoury
authors.affiliation: Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Marcos
authors.initials: M
authors.lastname: De Lima
authors.affiliation: Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Brenda
authors.initials: B
authors.lastname: Sandmaier
authors.affiliation: Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Center for International Blood and Marrow Transplantation (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012074:Remission Induction; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute myeloid leukemia; allogeneic transplantation; complete remission; primary induction failure; relapse