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Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission. Biol Blood Marrow Transplant 2006 Feb;12(2):204-16 PMID: 16443518

Pubmed ID

16443518

Abstract

Controversy exists over whether pretransplantation consolidation chemotherapy affects the outcome of subsequent autotransplantation for acute myelogenous leukemia (AML). The current study was undertaken to determine the association between previous consolidation and outcome of autotransplantation for AML in first remission. Posttransplantation outcomes of 146 patients receiving no consolidation were compared with those of 244 patients receiving standard-dose (<1 gm/m(2)) and 249 patients receiving high-dose (1-3 gm/m(2)) cytarabine, using proportional hazards regression to adjust for differences in prognostic variables. One-year transplantation-related mortality was similar among the cohorts. Five-year relapse rates were 49% (95% confidence interval CI} = 39%-58%) with no consolidation, 35% (95% CI = 29%-42%) with standard-dose cytarabine, and 40% (95% CI = 33%-48%) with high-dose cytarabine (P = .07). Five-year leukemia-free survival rates were 39% (95% CI = 30%-47%) with no consolidation, 53% (95% CI = 46%-60%) with standard-dose cytarabine, and 48% (95% CI = 40%-56%) with high-dose cytarabine (P = .03). Similarly, 5-year overall survival was better in those patients receiving consolidation: 42% (95% CI = 34%-51%) with no consolidation, 59% (95% CI = 52%-65%) with standard-dose cytarabine, and 54% (95% CI = 46%-61%) with high-dose cytarabine (P = .01). Although most patients received 1 or 2 cycles of consolidation, the number of courses had no detectable effect on transplantation outcome. In multivariate analysis, risks of relapse and treatment failure were lower in the patients receiving consolidation, especially among those patients receiving blood cell grafts. Outcomes with standard-dose and high-dose cytarabine were similar. Based on our findings, we recommend that patients with AML in first remission receive consolidation before undergoing autotransplantation.

Author List

Tallman MS, Pérez WS, Lazarus HM, Gale RP, Maziarz RT, Rowe JM, Marks DI, Cahn JY, Bashey A, Bishop MR, Christiansen N, Frankel SR, García JJ, Ilhan O, Laughlin MJ, Liesveld J, Linker C, Litzow MR, Luger S, McCarthy PL, Milone GA, Pavlovsky S, Phillips GL, Russell JA, Saez RA, Schiller G, Sierra J, Weiner RS, Zander AR, Zhang MJ, Keating A, Weisdorf DJ, Horowitz 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-s2.0-31344460389   23 Citations

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

Adolescent
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Bone Marrow Transplantation
Child
Child, Preschool
Disease-Free Survival
Female
Humans
Infant
Leukemia, Myeloid, Acute
Male
Middle Aged
Remission Induction
Retrospective Studies
Survival Rate
Transplantation, Autologous
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796