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Acute Leukemia

Comparable outcomes between autologous and allogeneic transplant for adult acute myeloid leukemia in first CR

Bone Marrow Transplantation volume 51, pages 645–653 (2016)Cite this article

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Abstract

Although allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling donor (MSD) is a potentially curative post-remission treatment for adults with acute myeloid leukemia (AML) in their first CR, transplant-related morbidity and mortality remains a major drawback. We retrospectively compared the outcomes of patients who underwent autologous peripheral blood stem cell transplantation (auto-PBSCT; n=375) with those who underwent allogeneic bone marrow transplantation (allo-BMT; n=521) and allo-PBSCT (n=380) from MSDs for adults with AML/CR1, in which propensity score models were used to adjust selection biases among patients, primary physicians and institutions to overcome ambiguity in the patients’ background information. Both the multivariate analysis and propensity score models indicated that the leukemia-free survival rate of auto-PBSCT was not significantly different from that of allo-BMT (hazard ratio (HR), 1.23; 95% confidence interval (CI), 0.92 to 1.66; P=0.16) and allo-PBSCT (HR, 1.13; 95% CI, 0.85–1.51; P=0.40). The current results suggest that auto-PBSCT remains a promising alternative treatment for patients with AML/CR1 in the absence of an available MSD.

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Acknowledgements

We are grateful to Professor Yoshihisa Kodera at Aichi Medical University for his helpful advice and support on advancing the study over an entire period. We are indebted to Professor Yoshinobu Kanda at Jichi Medical University for kindly suggesting how to use the EZR software program. We thank all of the physicians and data managers who provided valuable transplantation data to the JSHCT, the Japan Marrow Donor Program and the TRUMP. We also thank the members of the Data Management Committees of JSHCT, Japan Marrow Donor Program and TRUMP for their assistance. This study was supported by grants from the Ministry of Education, Culture, Sports and Technology of Japan, a Research on Allergic Disease and Immunology (H26–106) in Health and Labor Science Grant from the Ministry of Health, Labour and Welfare of Japan, the SENSHIN Medical Research Foundation (Osaka, Japan), the Aichi Cancer Research Foundation (Nagoya, Japan), and the 24th General Assembly of the Japanese Association of Medical Sciences (Nagoya, Japan). The funders had no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript. The aim of this study was to retrospectively compare the outcomes of auto-PBSCT to those of allo-BMT and allo-PBSCT from MSD for adults with AML/CR1. The LFS of auto-PBSCT was not significantly different from that of allo-BMT and allo-PBSCT as post-transplant treatment for AML/CR1.

Author contributions

Akiyoshi Takami, Motonori Mizutani and Masahiko Hara designed the research and wrote the manuscript. Motonori Mizutani, Masahiko Hara and Akiyoshi Takami analyzed the data. Motonori Mizutani and Masahiko Hara performed the statistical analyses. All the authors contributed to the collection of the data and samples and critically reviewed and approved the final manuscript.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan

    M Mizutani & A Takami

  2. Department of Medical Innovation, Osaka University Hospital, Osaka, Japan

    M Hara

  3. Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan

    H Fujita

  4. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    J Aoki & H Kanamori

  5. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    K Ohashi

  6. Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan

    K Usuki

  7. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

  8. Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan

    T Chou

  9. Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan

    J Tanaka

  10. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

  11. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

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Mizutani, M., Hara, M., Fujita, H. et al. Comparable outcomes between autologous and allogeneic transplant for adult acute myeloid leukemia in first CR. Bone Marrow Transplant 51, 645–653 (2016). https://doi.org/10.1038/bmt.2015.349

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