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Acute Leukemias

Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years

Leukemia volume 29, pages 1041–1050 (2015)Cite this article

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Abstract

The preferred type of post-remission therapy (PRT) in patients with acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate, especially in patients at higher risk of nonrelapse mortality (NRM), including patients >40 years of age. We report results of a time-dependent multivariable analysis of allogenic hematopoietic stem cell transplantation (alloHSCT) (n=337) versus chemotherapy (n=271) or autologous HSCT (autoHSCT) (n=152) in 760 patients aged 40–60 years with AML in CR1. Patients receiving alloHSCT showed improved overall survival (OS) as compared with chemotherapy (respectively, 57±3% vs 40±3% at 5 years, P<0.001). Comparable OS was observed following alloHSCT and autoHSCT in patients with intermediate-risk AML (60±4 vs 54±5%). However, alloHSCT was associated with less relapse (hazard ratio (HR) 0.51, P<0.001) and better relapse-free survival (RFS) (HR 0.74, P=0.029) as compared with autoHSCT in intermediate-risk AMLs. AlloHSCT was applied following myeloablative conditioning (n=157) or reduced intensity conditioning (n=180), resulting in less NRM, but comparable outcome with respect to OS, RFS and relapse. Collectively, these results show that alloHSCT is to be preferred over chemotherapy as PRT in patients with intermediate- and poor-risk AML aged 40–60 years, whereas autoHSCT remains a treatment option to be considered in patients with intermediate-risk AML.

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Acknowledgements

We thank the Leukemia Working Group of the HOVON/SAKK Cooperative Groups for conception and design; Ine Meulendijks, Jan van Tuijn, Martine Testroote, Christel van Hooije (HOVON) and Christina Biaggi (SAKK) for collection and assembly of the data.

Author Contributions

JJC, JV, WLJvP and BL contributed to the study design; all authors provided the study materials or patients; all authors were involved in the collection and assembly of clinical data; JJC, JV, WLJvP and BL were involved in analyzing and interpreting the data and writing this report; and all authors reviewed and approved the final version of the manuscript.

Members of the HOVON and SAKK Leukemia Groups

LFV, currently Isala Hospital, Zwolle, The Netherlands; and GH, currently Radboud University Medical Centre, Nijmegen, The Netherlands. All participating HOVON-SAKK institutes and investigators can be found in the supplementary appendix.

Author information

Author notes

  1. J J Cornelissen, J Versluis, J R Passweg, W L J van Putten, M G Manz, J Maertens, H B Beverloo, P J M Valk, M van Marwijk Kooy, P W Wijermans, M R Schaafsma, B J Biemond, M-C Vekemans, D A Breems, L F Verdonck, M F Fey, M Jongen-Lavrencic, J J W M Janssen, G Huls, J Kuball, T Pabst, C Graux, H C Schouten, A Gratwohl, E Vellenga, G Ossenkoppele and B Löwenberg: Members of the HOVON and SAKK Leukemia Groups are listed before References.

Authors and Affiliations

  1. Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands

    J J Cornelissen, J Versluis, P J M Valk, M Jongen-Lavrencic & B Löwenberg

  2. Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland

    J R Passweg & A Gratwohl

  3. HOVON Data Center and Department of Trials and Statistics, Rotterdam, The Netherlands

    W L J van Putten

  4. Division of Hematology, University Hospital Zürich, Zürich, Switzerland

    M G Manz

  5. Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium

    J Maertens

  6. Department of Clinical Genetics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

    H B Beverloo

  7. Department of Internal medicine, Isala Hospital, Zwolle, The Netherlands

    M van Marwijk Kooy

  8. Department of Hematology, Haga Hospital, The Hague, The Netherlands

    P W Wijermans

  9. Department of Hematology, Medisch Spectrum Twente, Enschede, The Netherlands

    M R Schaafsma

  10. Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    B J Biemond

  11. Department of Hematology, Hôpital St Luc, Brussels, Belgium

    M-C Vekemans

  12. Department of Hematology, Stuivenberg Hospital, Antwerp, Belgium

    D A Breems

  13. Departments of Immunology and Hematology, University Medical Center, Utrecht, The Netherlands

    L F Verdonck & J Kuball

  14. Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland

    M F Fey & T Pabst

  15. Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands

    J J W M Janssen & G Ossenkoppele

  16. Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands

    G Huls & E Vellenga

  17. Department of Hematology, Mont-Godinne, Yvoir, Belgium

    C Graux

  18. Department of Hematology, University Hospital Maastricht, Maastricht, The Netherlands

    H C Schouten

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  1. J J Cornelissen
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Correspondence to J J Cornelissen.

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Cornelissen, J., Versluis, J., Passweg, J. et al. Comparative therapeutic value of post-remission approaches in patients with acute myeloid leukemia aged 40–60 years. Leukemia 29, 1041–1050 (2015). https://doi.org/10.1038/leu.2014.332

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