Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research
Identifieur interne : 001723 ( Pmc/Curation ); précédent : 001722; suivant : 001724Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research
Auteurs : Armand Keating [Canada] ; Gisela Dasilva [Brésil] ; Waleska S. Pérez [États-Unis] ; Vikas Gupta [Canada] ; Corey S. Cutler [États-Unis] ; Karen K. Ballen [États-Unis] ; Mitchell S. Cairo [États-Unis] ; Bruce M. Camitta [États-Unis] ; Richard E. Champlin [États-Unis] ; James L. Gajewski [États-Unis] ; Hillard M. Lazarus [États-Unis] ; Michael Lill [États-Unis] ; David I. Marks [Royaume-Uni] ; Chadi Nabhan [États-Unis] ; Gary J. Schiller [États-Unis] ; Gerald Socie [France] ; Jeffrey Szer [Australie] ; Martin S. Tallman [États-Unis] ; Daniel J. Weisdorf [États-Unis]Source :
- Haematologica [ 0390-6078 ] ; 2013.
Abstract
The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous
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DOI: 10.3324/haematol.2012.062059
PubMed: 22983587
PubMed Central: 3561424
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Pérez</name><affiliation wicri:level="1"><nlm:aff id="af3-0980185">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea></affiliation></author><author><name sortKey="Gupta, Vikas" sort="Gupta, Vikas" uniqKey="Gupta V" first="Vikas" last="Gupta">Vikas Gupta</name><affiliation wicri:level="1"><nlm:aff id="af1-0980185">Princess Margaret Hospital, University of Toronto, Ontario, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Princess Margaret Hospital, University of Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Cutler, Corey S" sort="Cutler, Corey S" uniqKey="Cutler C" first="Corey S." last="Cutler">Corey S. 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Lazarus</name><affiliation wicri:level="1"><nlm:aff id="af10-0980185">University Hospitals Case Medical Center, Cleveland, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University Hospitals Case Medical Center, Cleveland, OH</wicri:regionArea></affiliation></author><author><name sortKey="Lill, Michael" sort="Lill, Michael" uniqKey="Lill M" first="Michael" last="Lill">Michael Lill</name><affiliation wicri:level="1"><nlm:aff id="af11-0980185">Cedars-Sinai Medical Center, Los Angeles, CA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cedars-Sinai Medical Center, Los Angeles, CA</wicri:regionArea></affiliation></author><author><name sortKey="Marks, David I" sort="Marks, David I" uniqKey="Marks D" first="David I." last="Marks">David I. 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Schiller</name><affiliation wicri:level="1"><nlm:aff id="af14-0980185">UCLA Center for Health Sciences, Los Angeles, CA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>UCLA Center for Health Sciences, Los Angeles, CA</wicri:regionArea></affiliation></author><author><name sortKey="Socie, Gerald" sort="Socie, Gerald" uniqKey="Socie G" first="Gerald" last="Socie">Gerald Socie</name><affiliation wicri:level="1"><nlm:aff id="af15-0980185">Hopital Saint Louis, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Hopital Saint Louis, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Szer, Jeffrey" sort="Szer, Jeffrey" uniqKey="Szer J" first="Jeffrey" last="Szer">Jeffrey Szer</name><affiliation wicri:level="1"><nlm:aff id="af16-0980185">Royal Melbourne Hospital City Campus, Victoria, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Royal Melbourne Hospital City Campus, Victoria</wicri:regionArea></affiliation></author><author><name sortKey="Tallman, Martin S" sort="Tallman, Martin S" uniqKey="Tallman M" first="Martin S." last="Tallman">Martin S. Tallman</name><affiliation wicri:level="1"><nlm:aff id="af17-0980185">Memorial Sloan Kettering Cancer Center, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Memorial Sloan Kettering Cancer Center, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Weisdorf, Daniel J" sort="Weisdorf, Daniel J" uniqKey="Weisdorf D" first="Daniel J." last="Weisdorf">Daniel J. Weisdorf</name><affiliation wicri:level="1"><nlm:aff id="af18-0980185">University of Minnesota Medical Center, Minneapolis, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Minnesota Medical Center, Minneapolis, MN</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22983587</idno><idno type="pmc">3561424</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561424</idno><idno type="RBID">PMC:3561424</idno><idno type="doi">10.3324/haematol.2012.062059</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">001863</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001863</idno><idno type="wicri:Area/Pmc/Curation">001723</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001723</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Autologous blood cell transplantation <italic>versus</italic> HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research</title><author><name sortKey="Keating, Armand" sort="Keating, Armand" uniqKey="Keating A" first="Armand" last="Keating">Armand Keating</name><affiliation wicri:level="1"><nlm:aff id="af1-0980185">Princess Margaret Hospital, University of Toronto, Ontario, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Princess Margaret Hospital, University of Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Dasilva, Gisela" sort="Dasilva, Gisela" uniqKey="Dasilva G" first="Gisela" last="Dasilva">Gisela Dasilva</name><affiliation wicri:level="1"><nlm:aff id="af2-0980185">University of Sao Paulo-Brazil, Sao Paulo, Brazil</nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>University of Sao Paulo-Brazil, Sao Paulo</wicri:regionArea></affiliation></author><author><name sortKey="Perez, Waleska S" sort="Perez, Waleska S" uniqKey="Perez W" first="Waleska S." last="Pérez">Waleska S. Pérez</name><affiliation wicri:level="1"><nlm:aff id="af3-0980185">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea></affiliation></author><author><name sortKey="Gupta, Vikas" sort="Gupta, Vikas" uniqKey="Gupta V" first="Vikas" last="Gupta">Vikas Gupta</name><affiliation wicri:level="1"><nlm:aff id="af1-0980185">Princess Margaret Hospital, University of Toronto, Ontario, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Princess Margaret Hospital, University of Toronto, Ontario</wicri:regionArea></affiliation></author><author><name sortKey="Cutler, Corey S" sort="Cutler, Corey S" uniqKey="Cutler C" first="Corey S." last="Cutler">Corey S. Cutler</name><affiliation wicri:level="1"><nlm:aff id="af4-0980185">Dana Farber Cancer Institute, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Dana Farber Cancer Institute, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Ballen, Karen K" sort="Ballen, Karen K" uniqKey="Ballen K" first="Karen K." last="Ballen">Karen K. Ballen</name><affiliation wicri:level="1"><nlm:aff id="af5-0980185">Massachusetts General Hospital, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Massachusetts General Hospital, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Cairo, Mitchell S" sort="Cairo, Mitchell S" uniqKey="Cairo M" first="Mitchell S." last="Cairo">Mitchell S. Cairo</name><affiliation wicri:level="1"><nlm:aff id="af6-0980185">New York Medical College, Valhalla, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>New York Medical College, Valhalla, NY</wicri:regionArea></affiliation></author><author><name sortKey="Camitta, Bruce M" sort="Camitta, Bruce M" uniqKey="Camitta B" first="Bruce M." last="Camitta">Bruce M. Camitta</name><affiliation wicri:level="1"><nlm:aff id="af7-0980185">Children's Hospital of Wisconsin, Milwaukee, WI, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Children's Hospital of Wisconsin, Milwaukee, WI</wicri:regionArea></affiliation></author><author><name sortKey="Champlin, Richard E" sort="Champlin, Richard E" uniqKey="Champlin R" first="Richard E." last="Champlin">Richard E. Champlin</name><affiliation wicri:level="1"><nlm:aff id="af8-0980185">MD Anderson Cancer Center, Houston, TX, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>MD Anderson Cancer Center, Houston, TX</wicri:regionArea></affiliation></author><author><name sortKey="Gajewski, James L" sort="Gajewski, James L" uniqKey="Gajewski J" first="James L." last="Gajewski">James L. Gajewski</name><affiliation wicri:level="1"><nlm:aff id="af9-0980185">Oregon Health and Science University, Portland, OR, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Oregon Health and Science University, Portland, OR</wicri:regionArea></affiliation></author><author><name sortKey="Lazarus, Hillard M" sort="Lazarus, Hillard M" uniqKey="Lazarus H" first="Hillard M." last="Lazarus">Hillard M. Lazarus</name><affiliation wicri:level="1"><nlm:aff id="af10-0980185">University Hospitals Case Medical Center, Cleveland, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University Hospitals Case Medical Center, Cleveland, OH</wicri:regionArea></affiliation></author><author><name sortKey="Lill, Michael" sort="Lill, Michael" uniqKey="Lill M" first="Michael" last="Lill">Michael Lill</name><affiliation wicri:level="1"><nlm:aff id="af11-0980185">Cedars-Sinai Medical Center, Los Angeles, CA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cedars-Sinai Medical Center, Los Angeles, CA</wicri:regionArea></affiliation></author><author><name sortKey="Marks, David I" sort="Marks, David I" uniqKey="Marks D" first="David I." last="Marks">David I. Marks</name><affiliation wicri:level="1"><nlm:aff id="af12-0980185">Bristol Children's Hospital, Bristol, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Bristol Children's Hospital, Bristol</wicri:regionArea></affiliation></author><author><name sortKey="Nabhan, Chadi" sort="Nabhan, Chadi" uniqKey="Nabhan C" first="Chadi" last="Nabhan">Chadi Nabhan</name><affiliation wicri:level="1"><nlm:aff id="af13-0980185">Advocate Lutheran General Hospital, Park Ridge, IL, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Advocate Lutheran General Hospital, Park Ridge, IL</wicri:regionArea></affiliation></author><author><name sortKey="Schiller, Gary J" sort="Schiller, Gary J" uniqKey="Schiller G" first="Gary J." last="Schiller">Gary J. Schiller</name><affiliation wicri:level="1"><nlm:aff id="af14-0980185">UCLA Center for Health Sciences, Los Angeles, CA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>UCLA Center for Health Sciences, Los Angeles, CA</wicri:regionArea></affiliation></author><author><name sortKey="Socie, Gerald" sort="Socie, Gerald" uniqKey="Socie G" first="Gerald" last="Socie">Gerald Socie</name><affiliation wicri:level="1"><nlm:aff id="af15-0980185">Hopital Saint Louis, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Hopital Saint Louis, Paris</wicri:regionArea></affiliation></author><author><name sortKey="Szer, Jeffrey" sort="Szer, Jeffrey" uniqKey="Szer J" first="Jeffrey" last="Szer">Jeffrey Szer</name><affiliation wicri:level="1"><nlm:aff id="af16-0980185">Royal Melbourne Hospital City Campus, Victoria, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Royal Melbourne Hospital City Campus, Victoria</wicri:regionArea></affiliation></author><author><name sortKey="Tallman, Martin S" sort="Tallman, Martin S" uniqKey="Tallman M" first="Martin S." last="Tallman">Martin S. Tallman</name><affiliation wicri:level="1"><nlm:aff id="af17-0980185">Memorial Sloan Kettering Cancer Center, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Memorial Sloan Kettering Cancer Center, New York, NY</wicri:regionArea></affiliation></author><author><name sortKey="Weisdorf, Daniel J" sort="Weisdorf, Daniel J" uniqKey="Weisdorf D" first="Daniel J." last="Weisdorf">Daniel J. Weisdorf</name><affiliation wicri:level="1"><nlm:aff id="af18-0980185">University of Minnesota Medical Center, Minneapolis, MN, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Minnesota Medical Center, Minneapolis, MN</wicri:regionArea></affiliation></author></analytic><series><title level="j">Haematologica</title><idno type="ISSN">0390-6078</idno><idno type="eISSN">1592-8721</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous <italic>versus</italic> allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) <italic>versus</italic> autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); <italic>P</italic>=0.13 and <italic>P</italic>=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); <italic>P</italic>=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); <italic>P</italic>=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); <italic>P</italic>=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Haematologica</journal-id><journal-id journal-id-type="iso-abbrev">Haematologica</journal-id><journal-id journal-id-type="publisher-id">Haematologica</journal-id><journal-id journal-id-type="hwp">haematol</journal-id><journal-title-group><journal-title>Haematologica</journal-title></journal-title-group><issn pub-type="ppub">0390-6078</issn><issn pub-type="epub">1592-8721</issn><publisher><publisher-name>Ferrata Storti Foundation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22983587</article-id><article-id pub-id-type="pmc">3561424</article-id><article-id pub-id-type="doi">10.3324/haematol.2012.062059</article-id><article-id pub-id-type="publisher-id">0980185</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject><subj-group><subject>Stem Cell Transplantation</subject></subj-group></subj-group></article-categories><title-group><article-title>Autologous blood cell transplantation <italic>versus</italic> HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Keating</surname><given-names>Armand</given-names></name><xref ref-type="aff" rid="af1-0980185"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>DaSilva</surname><given-names>Gisela</given-names></name><xref ref-type="aff" rid="af2-0980185"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pérez</surname><given-names>Waleska S.</given-names></name><xref ref-type="aff" rid="af3-0980185"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gupta</surname><given-names>Vikas</given-names></name><xref ref-type="aff" rid="af1-0980185"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cutler</surname><given-names>Corey S.</given-names></name><xref ref-type="aff" rid="af4-0980185"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ballen</surname><given-names>Karen K.</given-names></name><xref ref-type="aff" rid="af5-0980185"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cairo</surname><given-names>Mitchell S.</given-names></name><xref ref-type="aff" rid="af6-0980185"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Camitta</surname><given-names>Bruce M.</given-names></name><xref ref-type="aff" rid="af7-0980185"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Champlin</surname><given-names>Richard E.</given-names></name><xref ref-type="aff" rid="af8-0980185"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gajewski</surname><given-names>James L.</given-names></name><xref ref-type="aff" rid="af9-0980185"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lazarus</surname><given-names>Hillard M.</given-names></name><xref ref-type="aff" rid="af10-0980185"><sup>10</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lill</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="af11-0980185"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marks</surname><given-names>David I.</given-names></name><xref ref-type="aff" rid="af12-0980185"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nabhan</surname><given-names>Chadi</given-names></name><xref ref-type="aff" rid="af13-0980185"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Schiller</surname><given-names>Gary J.</given-names></name><xref ref-type="aff" rid="af14-0980185"><sup>14</sup></xref></contrib><contrib contrib-type="author"><name><surname>Socie</surname><given-names>Gerald</given-names></name><xref ref-type="aff" rid="af15-0980185"><sup>15</sup></xref></contrib><contrib contrib-type="author"><name><surname>Szer</surname><given-names>Jeffrey</given-names></name><xref ref-type="aff" rid="af16-0980185"><sup>16</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tallman</surname><given-names>Martin S.</given-names></name><xref ref-type="aff" rid="af17-0980185"><sup>17</sup></xref></contrib><contrib contrib-type="author"><name><surname>Weisdorf</surname><given-names>Daniel J.</given-names></name><xref ref-type="aff" rid="af18-0980185"><sup>18</sup></xref><xref rid="c1-0980185" ref-type="corresp"></xref></contrib></contrib-group><aff id="af1-0980185"><label>1</label>Princess Margaret Hospital, University of Toronto, Ontario, Canada</aff><aff id="af2-0980185"><label>2</label>University of Sao Paulo-Brazil, Sao Paulo, Brazil</aff><aff id="af3-0980185"><label>3</label>Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA</aff><aff id="af4-0980185"><label>4</label>Dana Farber Cancer Institute, Boston, MA, USA</aff><aff id="af5-0980185"><label>5</label>Massachusetts General Hospital, Boston, MA, USA</aff><aff id="af6-0980185"><label>6</label>New York Medical College, Valhalla, NY, USA</aff><aff id="af7-0980185"><label>7</label>Children's Hospital of Wisconsin, Milwaukee, WI, USA</aff><aff id="af8-0980185"><label>8</label>MD Anderson Cancer Center, Houston, TX, USA</aff><aff id="af9-0980185"><label>9</label>Oregon Health and Science University, Portland, OR, USA</aff><aff id="af10-0980185"><label>10</label>University Hospitals Case Medical Center, Cleveland, OH, USA</aff><aff id="af11-0980185"><label>11</label>Cedars-Sinai Medical Center, Los Angeles, CA, USA</aff><aff id="af12-0980185"><label>12</label>Bristol Children's Hospital, Bristol, UK</aff><aff id="af13-0980185"><label>13</label>Advocate Lutheran General Hospital, Park Ridge, IL, USA</aff><aff id="af14-0980185"><label>14</label>UCLA Center for Health Sciences, Los Angeles, CA, USA</aff><aff id="af15-0980185"><label>15</label>Hopital Saint Louis, Paris, France</aff><aff id="af16-0980185"><label>16</label>Royal Melbourne Hospital City Campus, Victoria, Australia</aff><aff id="af17-0980185"><label>17</label>Memorial Sloan Kettering Cancer Center, New York, NY, USA</aff><aff id="af18-0980185"><label>18</label>University of Minnesota Medical Center, Minneapolis, MN, USA</aff><author-notes><corresp id="c1-0980185">Correspondence: <email>weisd001@umn.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2013</year></pub-date><volume>98</volume><issue>2</issue><fpage>185</fpage><lpage>192</lpage><history><date date-type="received"><day>23</day><month>1</month><year>2012</year></date><date date-type="accepted"><day>05</day><month>9</month><year>2012</year></date></history><permissions><copyright-statement>©2013 Ferrata Storti Foundation</copyright-statement></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="98185.pdf"></self-uri><abstract><p>The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous <italic>versus</italic> allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) <italic>versus</italic> autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); <italic>P</italic>=0.13 and <italic>P</italic>=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); <italic>P</italic>=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); <italic>P</italic>=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); <italic>P</italic>=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.</p></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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