ACTA FAC MED NAISS 2011;28(4):201-207

Original article

UDC:616.155.392:616.419-089.843

Early Hematopoietic Cell Transplantation Results in Higher Overall Survival and Leukemia Free Survival Compared to               Conventional Chemotherapy in High Risk Acute Myeloid Leukaemia (AML) Patients

Nadežda Basara¹, Antje Schulze², Herbert Sayer³

¹University Medical School Leipzig

²Department of Hematology/Oncology HELIOS Clinic Erfurt

³Fridrich Schiller University Jena, Germany


summary

Between 1996 and 2004, a total of 708 patients were enrolled in the AML ´96 and 2002 studies of the East German Study Group. Of those, 138 patients (19.5%) had unfavourable cytogenetics defined as complex karyotype, del (5q)/-5, del (7q)/-7, abn (3q26) and abn (11q23). Seventy-seven (56%) patients achieved CR1 after induction chemotherapy and were eligible for HCT. HCT was performed after a median of two cycles of consolidation chemotherapies in the AML ´96 and one cycle in the AML 2002 (p=0.03). After a median follow-up of 21 months, OS amounted 73±14%, 50±14% and 14±8% at 3 years for patients after related HCT, unrelated HCT and chemotherapy, respectively (p=.008). Differences in outcomes were mainly due to a lower relapse incidence (26±13% for related and 48±15% for unrelated HCT) in patients after HCT compared to a higher relapse incidence in patients undergoing consolidation chemotherapy (89±8%; p=.003). Treatment-related mortality was low and not statistically significantly different between the three treatment groups (10±9%, 14±10% and 6± 6% for related, unrelated and chemotherapy; p=0.98). We conclude that early HCT from related or unrelated donors led to significantly better OS and LFS compared to chemotherapy in patients with unfavourable karyotype.

Key words: AML, hematopoietic stem cell transplantation, transplant-related mortality, overall survival