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AML patients are generally older, more frail and unable to tolerate intensive chemotherapy. Despite initial complete remission (CR), they have worse outcomes due to frequent disease relapse, occurring often within first 12–18 months. The optimal consolidation treatment regimen for these patients has not yet been determined. Celalettin Ustun from Rush University, Chicago, US and colleagues published results of a retrospective study in Leukemia, comparing outcomes for older patients receiving allogenic hematopoietic cell transplantation (allo-HSCT) with chemotherapy (CT) consolidation.1
Table 1. Significant findings from the multivariate analysis.
TRM treatment-related mortality, DFS disease-free survival, OS overall survival, HR hazard ratio |
||||||||
Variables |
TRM |
Relapse |
DFS |
OS |
||||
---|---|---|---|---|---|---|---|---|
HR |
P value |
HR |
P value |
HR |
P value |
HR |
P value |
|
Therapy |
|
0.0003* |
|
0.0002* |
|
<0.0001 |
|
<0.0001 |
Before 9 months |
||||||||
CT |
1 |
|
1 |
|
1 |
|
1 |
|
Allo-HSCT |
2.81 |
0.001 |
1.04 |
0.82 |
1.38 |
0.03 |
1.52 |
0.02 |
After 9 months |
||||||||
CT |
1 |
|
1 |
|
1 |
|
1 |
|
Allo-HSCT |
0.74 |
0.22 |
0.42 |
<0.0001 |
0.52 |
<0.0001 |
0.53 |
<0.0001 |
Cytogenetic risk group |
|
0.52 |
|
<0.0001 |
|
<0.0001 |
|
<0.0001 |
Favourable/ intermediate |
1 |
|
1 |
|
1 |
|
1 |
|
Poor |
1.23 |
0.25 |
2.12 |
<0.0001 |
1.74 |
<0.0001 |
1.74 |
<0.0001 |
Missing |
1.03 |
0.91 |
1.32 |
0.12 |
1.20 |
0.22 |
1.13 |
0.43 |
Table 2. Multivariate analysis within the allo-HSCT group.
TRM treatment-related mortality, DFS disease-free survival, OS overall survival, HR hazard ratio, MAC myeloablative conditioning, NMA nonmyeloablative, RIC reduced-intensity conditioning, MURD matched unrelated donor, MMURD mismatched unrelated donor, UCB umbilical cord blood |
||||||||
Variables |
TRM |
Relapse |
DFS |
OS |
||||
---|---|---|---|---|---|---|---|---|
HR |
P value |
HR |
P value |
HR |
P value |
HR |
P value |
|
Conditioning intensity |
|
|
|
|
|
|
|
|
MAC |
1 |
|
1 |
|
1 |
|
1 |
|
NMA/RIC |
0.99 |
0.95 |
1.39 |
0.11 |
1.19 |
0.24 |
1.14 |
0.39 |
Donor type |
|
0.0004 |
|
0.07 |
|
0.0003 |
|
<0.0001 |
HLA-identical sibling |
1 |
|
1 |
|
1 |
|
1 |
|
HLA partially |
1.47 |
0.26 |
0.70 |
0.23 |
0.94 |
0.79 |
1.05 |
0.85 |
HLA-well matched URD |
1.23 |
0.42 |
0.73 |
0.1 |
0.88 |
0.44 |
0.97 |
0.85 |
UCB |
2.69 |
0.0002 |
1.18 |
0.45 |
1.65 |
0.003 |
1.87 |
0.0002 |
The study indicates improved long-term survival and reduced relapse risk in older patients with AML in CR1 on allo-HSCT therapy, especially in higher-risk populations. However, allo-HSCT was associated with higher early risk from TRM and may not suitable for patients with comorbidities. The large number of patients from multiple centres included in the analysis, especially inclusion of older patients, availability of cytogenetic data, and the long follow-up were the key strengths of the study. Also, the allo-HSCT cohort with different donor types and conditioning regiments representing broad clinical practice further strengthen the data.
The study limitations included a lack of data on; molecular profiling, minimal residual disease, comorbidities and geriatric assessment. Additionally, the CT cohort of the study may not have reflected the general population of older AML patients due to stringent selection criteria used.
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