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Study: Consider HCT for all high-risk AML, ALL

Leung W. Blood. 2011;doi:10.1182/blood-2011-01-333070.

Issue: August 25, 2011

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In recent years, survival has more than doubled among young patients with high-risk leukemia who underwent bone marrow transplant at St. Jude Children’s Research Hospital, according to recent data. Survival gains were most notable among patients without genetically matched donors.

Researchers from St. Jude Children’s Research Hospital in Memphis, Tenn., completed two leukemia treatment protocols that resulted in improved outcomes among pediatric patients with acute lymphoblastic leukemia and acute myeloid leukemia. The purpose of the current study was to determine whether contemporary protocols (allogeneic hematopoietic cell transplantation after intensive, multi-agent chemotherapy) increased the risk for relapse or toxic death and whether non-HLA identical hematopoietic cell transplantation (HCT) resulted in poor outcomes. Eighty-three children were treated with contemporary protocols and 107 were treated in previous protocols.

Patients treated with contemporary protocols (between 2000 and 2007) had higher 5-year OS (65% for patients with ALL and 74% for those with AML) compared with those treated with previous protocols (between 1991 and 1999; 28% for those with ALL and 34% for those with AML). These improvements were noted despite donor type (sibling: 70% vs. 24%; unrelated: 61% vs. 37% and haploidentical: 88% vs. 19%), according to the researchers. Contemporary protocol was also associated with less infection (HR=0.12; P=.005), regimen-related toxicity (HR=0.25; P=.002) and leukemia-related death (HR=0.40; P=.01).

Patients in first remission were more likely to have improved survival compared with those with more advanced disease (HR=0.63; P=.03). The same was true for patients with minimal residual disease at the time of transplantation (positive vs. negative; HR=2.10; P=.01).

“Our results indicate that all patients with very high-risk leukemia should be considered as candidates for HCT early in the course of diagnosis or relapse treatment, regardless of the availability of a matched donor or the intensity of prior chemotherapy,” the researchers wrote. “HLA typing, donor search and transplant center referral should be performed as soon as possible.”

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