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Allogeneic hematopoietic cell transplantation improved QOL-adjusted survival
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Older patients with a related donor and younger patients with unfavorable cytogenetics enjoyed the most quality-of-life–adjusted benefit from allogeneic hematopoietic cell transplantation in first complete remission, according to results from a Japanese study.
Researchers built a new database with clinical data on 2,029 adults diagnosed with acute myeloid leukemia from 1999 to 2006 and treated at 70 medical facilities in Japan. Median follow-up with surviving patients was 49.8 months.
There were 494 patients who underwent allogeneic hematopoietic cell transplantation (HCT) in first complete remission and 1,535 who underwent chemotherapy. Patients in the transplantation group were younger and were more often associated with unfavorable features compared with those in the chemotherapy group.
Overall, life expectancy in the transplantation group was superior (69.7 months vs. 66.7 months). However, quality-adjusted life expectancy was 55.9 months in the transplantation group compared with 55.4 months in the chemotherapy group.
“The life expectancy was generally shortened to a greater degree in the HCT group after adjustment for QOL,” the researchers wrote. “This trend was consistent throughout all of the subgroups.”
Life expectancy was longer among patients with favorable-risk AML treated with 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 in the transplantation group had a longer life expectancy.
In patients aged 16 to 49 years, researchers found that those with favorable-risk disease had longer life expectancy and quality-adjusted life expectancy when assigned to chemotherapy. However, transplantation was associated with superior life expectancy in both the unfavorable-risk group (62.8 months vs. 55.3 months) and donor group (73 months vs. 67.6 months). After adjusting for quality of life, quality-adjusted life expectancy was longer for those in the transplantation group.
Life expectancy was longer among all subgroups for patients aged 50 to 70 years who underwent transplantation. The difference in duration of life between the two treatment groups shrank after adjustment for quality of life, but researchers found that the difference in quality-adjusted life expectancy was greatest among patients who had a suitable related donor (57.7 vs 40.4 months).
For more information:
- Kurosawa S. Blood. 2010;doi:10.1182/blood-2010-05-285502.