Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission

Erica D. Warlick, Kristjan Paulson, Ruta Brazauskas, Xiaobo Zhong, Alan M. Miller, Bruce M. Camitta, Biju George, Bipin N. Savani, Celalettin Ustun, David I. Marks, Edmund K. Waller, Frédéric Baron, César O. Freytes, Gérard Socie, Gorgun Akpek, Harry C. Schouten, Hillard M. Lazarus, Edwin M. Horwitz, John Koreth, Jean Yves CahnMartin Bornhauser, Matthew Seftel, Mitchell S. Cairo, Mary J. Laughlin, Mitchell Sabloff, Olle Ringdén, Robert Peter Gale, Rammurti T. Kamble, Ravi Vij, Usama Gergis, Vikram Mathews, Wael Saber, Yi Bin Chen, Jane L. Liesveld, Corey S. Cutler, Armin Ghobadi, Geoffrey L. Uy, Mary Eapen, Daniel J. Weisdorf, Mark R. Litzow

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P= 16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P= 15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P= 80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number2
DOIs
StatePublished - Feb 2014

Bibliographical note

Funding Information:
Financial disclosure: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24 CA076518 from the National Cancer Institute (NCI) , the National Heart, Lung and Blood Institute (NHLBI) , and the National Institute of Allergy and Infectious Diseases ; Grant/Cooperative Agreement U10 HL069294 from the NHLBI and NCI; contract HHSH250201200016C from Health Resources and Services Administration/US Department of Health and Human Services; 2 grants ( N00014-12-1-0142 and N00014-13-1-0039 ) from the Office of Naval Research ; and grants from Allos Therapeutics, Inc. ; Amgen, Inc. ; Anonymous donation to the Medical College of Wisconsin ; Ariad ; Be the Match Foundation ; Blue Cross and Blue Shield Association; Celgene Corporation ; Fresenius-Biotech North America, Inc. ; Gamida Cell Teva Joint Venture Ltd. ; Genentech, Inc. ; Gentium SpA ; Genzyme Corporation ; GlaxoSmithKline ; Histogenetics, Inc. ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin ; Merck & Co, Inc. ; Millennium: The Takeda Oncology Co. ; Milliman USA, Inc. ; Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Onyx Pharmaceuticals ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; Remedy Informatics ; Sanofi US ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; StemCyte, A Global Cord Blood Therapeutics Co .; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; Tarix Pharmaceuticals ; TerumoBCT ; Teva Neuroscience, Inc. ; THERAKOS, Inc. ; and Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government.

Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.

Keywords

  • AML
  • Cytarabine consolidation
  • RIC

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