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Chemotherapy only compared to chemotherapy followed by transplantation in high risk myelodysplastic syndrome and secondary acute myeloid leukemia; two parallel studies adjusted for various prognostic factors

Leukemia volume 16, pages 1615–1621 (2002)Cite this article

Abstract

Comparisons of the effectiveness of chemotherapy and transplantation in AML in first complete remission (CR) have focused almost exclusively on patients with de novo disease. Here we used Cox modelling to compare these strategies in patients with MDS and s-AML treated by the Leukemia Group of the EORTC or at the MD Anderson Cancer Center. All patients were aged 15–60. The 184 EORTC patients received conventional dose ara-C + idarubicin + etoposide for remission induction, and after one consolidation course, were scheduled to receive an allograft, or an autograft if a sibling donor was unavailable. The 215 MDA patients received various high-dose ara-C containing induction regimens, and in CR, continued to receive these regimens at reduced dose for 6–12 months. CR rates were 54% EORTC and 63% MDA (P = 0.09). Sixty-five of the 100 EORTC patients who entered CR received a transplant in first CR. Disease-free survival in patients achieving CR was superior in the EORTC cohort, the 4-years DFS rates were 28.9% (s.e. = 4.8%) EORTC vs 17.3% (s.e. = 3.7%) MDA (P = 0.017). Survival from CR was not significantly different in the EORTC and MDA groups, as was survival from start of treatment. After accounting for prognostic factors the conclusions were unchanged. Despite various problems with the analysis discussed below, the data suggest that neither transplantation nor chemotherapy, as currently practised, can be unequivocally recommended for these patients in first CR and that questions as to the superior modality may be less important than the need to improve results with both.

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Acknowledgements

J Cortes is a Leukemia and Lymphoma Society Scholar in Clinical Research.

Author information

Authors and Affiliations

  1. University Medical Centre Nijmegen, The Netherlands

    M Oosterveld, P Muus & T de Witte

  2. EORTC Data Center, Brussels, Belgium

    S Suciu

  3. MD Anderson Cancer Center, Houston, Texas, USA

    C Koller, J Cortes & E Estey

  4. University Hospital Gasthuisberg, Leuven, Belgium

    G Verhoef

  5. Clinical Hospital Rebro, Zagreb, Croatia

    B Labar

  6. Leijenburg Hospital, The Hague, The Netherlands

    P Wijermans

  7. Heinrich Heine University, Dusseldorf, Germany

    C Aul

  8. Hôpital Edouard Herriot, Lyon, France

    D Fière

  9. St Jan's Hospital, Brugge, Belgium

    D Selleslag

  10. Leiden University Medical Centre, Leiden, The Netherlands

    R Willemze

  11. Kantonsspital, Basel, Switzerland

    A Gratwohl

  12. Cliniques Universitaires St Luc, Brussels, Belgium

    A Ferrant

  13. University La Sapienza, Roma, Italy

    F Mandelli

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for the EORTC, EBMT, SAKK, GIMEMA Leukemia Groups and the MD Anderson Cancer Center

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Oosterveld, M., Muus, P., Suciu, S. et al. Chemotherapy only compared to chemotherapy followed by transplantation in high risk myelodysplastic syndrome and secondary acute myeloid leukemia; two parallel studies adjusted for various prognostic factors. Leukemia 16, 1615–1621 (2002). https://doi.org/10.1038/sj.leu.2402591

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