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Allo-HCT in first complete remission extended life expectancy for some intermediate- and unfavorable-risk AML
Kurosawa S. Blood. 2011;117:2113-2120.
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Results from a study of more than 2,000 patients with acute myeloid leukemia showed that allogeneic hematopoietic cell transplantation, or allo-HCT, extended life expectancy for those with intermediate- or unfavorable-risk disease. However, transplantation was not associated with longer quality-adjusted life expectancy.
In contrast, patients with favorable-risk AML had superior life expectancy when they were treated with chemotherapy.
Researchers in Japan constructed a database of 2,029 adults diagnosed with AML from 1999 to 2006. Eligible patients had first complete remission after no more than two courses of induction chemotherapy. Researchers collected the patient information from more than 70 institutions across the country.
Most patients (79%) underwent chemotherapy at first complete remission, whereas 24% underwent transplantation. The median time from remission to transplantation was 4.7 months.
For all ages, researchers said life expectancy was superior in the transplantation group, 69.7 months vs. 66.7 months. However, the difference almost disappeared when researchers analyzed quality-adjusted life expectancy, 55.9 months vs. 55.4 months.
Transplantation was associated with a reduced quality-adjusted life expectancy, but quality-adjusted life expectancy was longer for patients assigned to transplantation in the intermediate-risk (59.4 months vs. 55.6 months) and unfavorable-risk (47.6 months vs. 44.4 months) categories. Quality-adjusted life expectancy still favored chemotherapy in patients with favorable-risk disease (56 months vs. 64.3 months).
Researchers found that patients with favorable-risk disease had a longer life expectancy when assigned to chemotherapy. In contrast, patients with intermediate- (73.6 months vs. 66.4 months), unfavorable- (61.6 months vs. 53.4 months) and unknown-risk AML had superior life expectancy when assigned to transplantation.
The norm has been that patients with good risk don’t get transplanted and those with poor risk do. The intermediate group is really the more difficult group to know how to treat. The problem is that the intermediate group is a mishmash of good and poor risk. These new molecular markers are helping us distinguish that. The intermediate risk group has been primarily the normal chromosome group by cytogenetics and with these novel molecular markers, we’ve been able to separate those patients into a poor risk group and a better risk group. What these results show is that there may be an advantage associated with transplant for patients with higher risk disease. Unfortunately, this is a retrospective study where many of the transplants were performed prior to the availability of the molecular markers.
– Nelson J. Chao, MD, MBA
Donald D. and
Elizabeth G. Cooke Professor of Medicine and Immunology, Duke University
Disclosures: Dr. Chao reported no relevant disclosures.
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