We compared the outcomes of patients age 60-70 years with acute myelogenous leukemia receiving reduced-intensity allogeneic hematopoietic cell transplantation (HCT) in first remission (CR1) reported to the Center for International Blood and Marrow Research (n = 94) with the outcomes in patients treated with induction and postremission chemotherapy on Cancer and Leukemia Group B protocols (n = 96). All patients included had been in CR1 for at least 4 months. The HCT recipients were slightly younger than the chemotherapy patients (median age, 63 years vs 65 years; P <.001), but there were no significant between-group differences in the proportion with therapy-related leukemia or in different cytogenetic risk groups. Time from diagnosis to CR1 was longer for the HCT recipients (median, 44 days vs 38 days; P =.031). Allogeneic HCT was associated with significantly lower risk of relapse (32% vs 81% at 3 years; P <.001), higher nonrelapse mortality (36% vs 4% at 3 years; P <.001), and longer leukemia-free survival (32% vs 15% at 3 years; P =.001). Although overall survival was longer for HCT recipients, the difference was not statistically significant (37% vs 25% at 3 years; P =.08). Our findings suggest that reduced-intensity conditioning allogeneic HCT in patients age 60-70 with acute myelogenous leukemia in CR1 reduces relapse and improves leukemia-free survival. Strategies that reduce nonrelapse mortality may yield significant improvements in overall survival.
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Financial Disclosure : The Center for International Blood and Marrow Research is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute, National Heart, Lung and Blood Institute , and National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement 5U01HL069294 from the National Heart, Lung and Blood Institute and National Cancer Institute ; Contract HHSH234200637015C from the Health Resources and Services Administration ; Grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research; and grants from AABB; Allos, Inc; Amgen, Inc ; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US, Inc; Be the Match Foundation; Biogen IDEC; BioMarin Pharmaceutical, Inc; Biovitrum AB; BloodCenter of Wisconsin; Blue Cross and Blue Shield Association; Bone Marrow Foundation; Buchanan Family Foundation; CaridianBCT; Celgene Corporation; CellGenix, GmbH; Children’s Leukemia Research Association; ClinImmune Labs; CTI Clinical Trial and Consulting Services; Eisai, Inc; Genentech, Inc; Genzyme Corporation; Histogenetics, Inc; HKS Medical Information Systems; Hospira, Inc; Kirin Brewery Co, Ltd; The Leukemia and Lymphoma Society; Merck & Company; The Medical College of Wisconsin; Millennium Pharmaceuticals, Inc; Miller Pharmacal Group; Milliman USA, Inc; Miltenyi Biotec, Inc; National Marrow Donor Program; Nature Publishing Group; Novartis Oncology; Oncology Nursing Society; Osiris Therapeutics, Inc; Otsuka America Pharmaceutical, Inc; Pall Life Sciences; Pfizer Inc; Schering Corporation; Sigma-Tau Pharmaceuticals; Soligenix, Inc; StemCyte, Inc; StemSoft Software, Inc; Sysmex America, Inc; THERAKOS, Inc; Vidacare Corporation; ViraCor Laboratories; ViroPharma, Inc; and Wellpoint, Inc The views expressed in this paper do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, or any other agency of the U.S. Government.
This research was supported in part by grants from the National Cancer Institute to Cancer and Leukemia Group B ( CA101140, CA31946, CA77658, CA33601, CA41287, CA47545, CA03927, CA47577, CA35279, and CA32291), NCI CA16058 , and the Coleman Leukemia Research Fund.
- Acute myeloid leukemia