Stem cell transplantation could be delayed in acute myeloid leukemia
medwireNews: Stem cell transplantation could be delayed until a relapse occurs, without affecting overall survival, in some patients with acute myeloid leukemia (AML), UK researchers report.
"The data suggest the possibility of producing the same number of survivors overall by reserving transplantation for relapse," write Alan Burnett (Cardiff University School of Medicine) and team in the Journal of Clinical Oncology.
This could result in fewer transplants, less transplant-associated morbidity, and reduced health-related interventions, the investigators suggest.
Using data from three Medical Research Council trials (AML 10, AML 12, and AML 15), Burnett and team set out to "quantify the prospects of salvage treatment" in patients who did not undergo stem cell transplantation (SCT) after achieving a first complete remission (CR1).
Five-year overall survival (OS) following relapse was higher in patients who achieved a first complete remission (CR1) but did not undergo stem cell transplantation (SCT), compared with those who did (19% of 1160 patients vs 7% of 1064 patients).
For patients who did not receive SCT in CR1, the 5-year OS rates were 32%, 17%, and 7% for favorable, intermediate, and adverse risk AML groups, respectively. Over half (55%) of these patients achieved a second clinical remission (CR2), with rates of 82%, 54%, and 27%, in the favorable, intermediate, and adverse risk groups, respectively.
The overall 5-year OS was 34% among the 642 patients who achieved a second complete remission (CR2); 67% received SCT, resulting in OS of 42%, compared with 16% among those given chemotherapy alone.
In an accompanying editorial, Charles Schiffer (Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, USA) notes that most patients who survived with just chemotherapy had favorable cytogenetic or molecular findings. However, he notes that the CR2 transplant rates reported here may be difficult to achieve beyond the clinical trial setting of this study.
"These data, particularly for intermediate-risk disease, indicate that the same survival can be achieved with fewer transplants by reserving the receipt of an SCT to CR2," Burnett and colleagues propose.
Although questions remain, these findings could aid discussion about whether, and if so when, to use SCT for AML patients in CR1.
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