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HLA-identical sibling allogeneic transplants versus chemotherapy in acute myelogenous leukemia with t(8;21) in first complete remission: collaborative study between the German AML Intergroup and CIBMTR. Biol Blood Marrow Transplant 2008 Feb;14(2):187-96 PMID: 18215779 PMCID: PMC2531160

Pubmed ID

18215779

Abstract

We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95% confidence interval [CI] 2.95-15.45, P < .001), lower relapse (RR 0.47, 95% CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 x 10(9)/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT.

Author List

Schlenk RF, Pasquini MC, Pérez WS, Zhang MJ, Krauter J, Antin JH, Bashey A, Bolwell BJ, Büchner T, Cahn JY, Cairo MS, Copelan EA, Cutler CS, Döhner H, Gale RP, Ilhan O, Lazarus HM, Liesveld JL, Litzow MR, Marks DI, Maziarz RT, McCarthy PL, Nimer SD, Sierra J, Tallman MS, Weisdorf DJ, Horowitz MM, Ganser A, CIBMTR Acute Leukemia Working Committee

Authors

Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Associate 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-s2.0-38349185874   34 Citations

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

Adolescent
Adult
Chromosomes, Human, Pair 21
Chromosomes, Human, Pair 8
Cohort Studies
Data Collection
Female
Hematopoietic Stem Cell Transplantation
Histocompatibility Testing
Humans
Leukemia, Myeloid, Acute
Male
Middle Aged
Prognosis
Remission Induction
Siblings
Survival Rate
Translocation, Genetic
Transplantation, Homologous
Treatment Failure
Treatment Outcome
jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6