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Chemotherapy versus transplants for acute myelogenous leukemia in second remission. Leukemia 1996 Jan;10(1):13-9 PMID: 8558917

Pubmed ID

8558917

Abstract

The best therapy for persons with acute myelogenous leukemia (AML) in 2nd remission is unknown. Bone marrow transplants from an HLA-identical sibling are reported to be better than chemotherapy but this is controversial. The objective of the study was to compare 3-year leukemia-free survival (LFS) in comparable subjects receiving chemotherapy or a transplant. 485 persons with AML in 2nd remission were studied. The chemotherapy cohort included 244 persons treated on trials of the British Medical Research Council, Eastern Cooperative Oncology Group and MD Anderson Hospital. The transplant cohort included 257 persons transplanted worldwide and reported to the international Bone Marrow Transplant Registry (16 were also chemotherapy subjects.) Subjects were selected for comparable age and year of treatment. Preliminary analyses identified two factors correlated with LFS: age < or = or > 30 years and 1st remission duration < or = or > 1 year; subsequent analyses were partitioned accordingly. Three-year probabilities of treatment-related mortality with chemotherapy and transplants were 7% (95% confidence interval, 3-15%) vs 56% (49-63%). Three-year leukemia relapse probabilities were 81% (74-86%) vs 41% (33-49%). Three-year probabilities of LFS were 17% (12-23%) vs 26 (20-32%). Cohort analysis showed significantly higher LFS with transplants vs chemotherapy in persons < or = 30 years and 1st remissions > 1 year (41% (29-53%) vs 17% (7-32%); P = 0.017) and those in > 30 years with 1st remissions < or = 1 year (18% (9-29%) vs 7% (2-16%); P = 0.046). Others had comparable LFS with both treatments. These data indicate better LFS with HLA-identical sibling transplants than chemotherapy in some persons with AML in 2nd remission.

Author List

Gale RP, Horowitz MM, Rees JK, Gray RG, Oken MM, Estey EH, Kim KM, Zhang MJ, Ash RC, Atkinson K, Champlin RE, Dicke KA, Gajewski JL, Goldman JM, Helbig W, Henslee-Downey PS, Hinterberger W, Jacobsen N, Keating A, Klein JP, Marmont AM, Prentice HG, Reiffers J, Rimm AA, Bortin MM

Authors

Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-9044235781   60 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Antineoplastic Combined Chemotherapy Protocols
Bone Marrow Transplantation
Child
Child, Preschool
Cohort Studies
Disease-Free Survival
Female
Humans
Infant
Leukemia, Myeloid, Acute
Male
Middle Aged
Remission Induction
Time Factors
Transplantation, Homologous
jenkins-FCD Prod-297 dff1a717c492f00bf6291286365f1f4fe95208f1