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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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.
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.
The authors declare no conflict of interest.
Supplementary Information accompanies this paper on the Leukemia website
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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) doi:10.1038/leu.2014.332
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