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AMLCG-99: Allogeneic transplantation preferred post-remission therapy for high-risk AML
Stelljes M. Haematologica. 2011;doi:10.3324/haematol.2011.041004.
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Allogeneic hematopoietic cell transplantation is the preferred treatment for patients diagnosed with acute myeloid leukemia with high-risk cytogenetics, according to results from a landmark study conducted in Germany.
From May 1999 to May 2007, 2,347 patients with untreated AML were recruited into AML CG-99. One hundred eleven patients were treated with induction therapy and had first complete remission within 58 days. Those patients were assigned to allogeneic hematopoietic cell transplantation (n=55) or conventional post-remission therapy (n=35).
Median follow-up was 60.4 months for surviving patients.
Five-year OS (48% vs. 16%) and 5-year relapse-free survival (40% vs. 13%) favored the transplantation group. Survival rates were similar whether or not donors were related (HR=0.77; 95% CI, 0.35-1.68).
In the intent-to-treat population, 5-year OS (48% vs. 18%) and relapse-free survival (39% vs. 10%) favored the transplantation group.
Forty-seven of 90 patients analyzed relapsed, 32.7% in the transplantation group compared with 82.8% in the control group. Relapse was more likely to be fatal for patients in the control group.
Median time from first complete remission to relapse was 545 days in the transplantation group vs. 229 days in the control group.
Patients transplanted from matched unrelated donors were more likely to relapse (19%) compared with those transplanted from matched related donors (48%). However, there were three non-relapse deaths (11%) among patients transplanted from matched related donors compared with 10 (36%) in patients transplanted from matched unrelated donors.
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