Unrelated matched versus autologous transplantation in adult patients with good and intermediate risk acute myelogenous leukemia in first molecular remission |
| |
| Authors: | Norbert‐Claude Gorin Myriam Labopin Thomas Pabst Peter Remenyi Depei Wu Anne Huynh Liisa Volin Jean Yves Cahn Ibrahim Yakoub‐Agha Melanie Mercier Mohamed Houhou Mohamad Mohty Arnon Nagler |
| |
| Affiliation: | 1. Department of Hematology and Cell Therapy and EBMT Paris Office, H?pital Saint‐Antoine APHP, INSERM U 938, Université Pierre et Marie Curie UPMC, Paris, France;2. Department of Oncology, University Hospital Bern, Bern, Switzerland;3. Department of Hematology and Stem Cell Transplant, Saint István and Saint Laszlo Hospital, Semmelweis University, Budapest, Hungary;4. Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou Jiangsu, China;5. Institut Universitaire du Cancer Toulouse, Oncopole, I.U.C.T‐O, Toulouse, France;6. HUCH Comprehensive Cancer Center Stem Cell Transplantation Unit, Helsinki, Finland;7. CHU Grenoble Alpes, Hématologie Clinique, Grenoble, France;8. CHU de Lille, LIRIC INSERM U995, Université Lille2, France;9. Centre Hospitalo Universitaire, Inserm U898, Angers, France;10. Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, EBMT ALWP Chair, Tel Hashomer, Israel |
| |
| Abstract: | Patients with Acute Myelogenous Leukemia have a better outcome if reaching molecular remission. We compared the outcome of 373 patients autografted and 335 patients allografted with a 10/10 compatible unrelated donor in first molecular remission. Patients were stratified using the ELN European Leukemia Net classification. ELN favorable group : (234 auto and 70 unrelated transplants). By univariate analysis, in the auto group, the Non Relapse Mortality (NRM) was lower (3.7% versus 19%; P < 10?4), Relapse Incidence (RI) higher (29% versus 17%, P < 10?4), Leukemia Free Survival (LFS) identical (67% versus 64%) and Overall Survival (OS) better than in the allogeneic group (83% versus 62%; P = .008). By multivariate analysis, autologous transplantation was associated with a lower NRM (HR: 4, P = .01) and a better OS (HR: 2.08, P = .04). ELN intermediate group 1 : (87 autologous and 172 unrelated transplants). By univariate analysis, in the auto group, NRM was lower (2.5% versus 11.8%; P = .03), RI higher (59% versus 18%, P < 10?6), LFS lower (39% versus 70%; P < 10?6) and OS lower than in the unrelated donor group (61% versus 74%; P = .005). By multivariate analysis, unrelated donor was superior to autologous transplantation for LFS (HR: 0.36, P < 10?5) and OS (HR: 0.53, P = .01). ELN intermediate group 2 : (52 autologous and 93 unrelated donors). The outcome was identical. We conclude that good risk patients get higher benefit from autologous transplantation. Intermediate risk 2 patients have the same outcome and Intermediate risk 1 patients get higher benefit from unrelated donor transplants. |
| |
| Keywords: | |
|
|
