The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60–77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5–5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29–0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24–34%) versus CT 13.8% (9–21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.
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We express our deepest appreciation to the late A H who contributed to this work from inception to the first draft of the paper. We are forever indebted to her efforts. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the award number UG1CA189823 to the Alliance for Clinical Trials in Oncology NCORP Research Base (Jan C. Buckner, M.D., contact PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Other grant award numbers are as follows: U10CA180819, CA180820, CA180794, CA180790, and CA180791.
CU and AA conceived the idea, searched literature, analyzed the data, wrote and edited the manuscript. JLR, BM, ES, HLW, MJZ, and DJW collected data, analyzed data, wrote and edited the manuscript. RS, RAL, AH, TCS, MDL, AJW, HPE, MST, FA, CDB, MO, JML, SC, GM, KM, BS, ECA, ML, and ZS helped data collection, wrote and edited the manuscript. SN, GJR, GLU, JMF, LDC, and AJ were the principal investigators of the relevant cooperative group studies, and wrote and edited the manuscript.
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Ustun, C., Le-Rademacher, J., Wang, HL. et al. Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. Leukemia 33, 2599–2609 (2019). https://doi.org/10.1038/s41375-019-0477-x
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