Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: A registry study from the center for international blood and marrow transplantation research

Armand Keating, Gisela DaSilva, Waleska S. Pérez, Vikas Gupta, Corey S. Cutler, Karen K. Ballen, Mitchell S. Cairo, Bruce M. Camitta, Richard E. Champlin, James L. Gajewski, Hillard M. Lazarus, Michael Lill, David I. Marks, Chadi Nabhan, Gary J. Schiller, Gerald Socie, Jeffrey Szer, Martin S. Tallman, Daniel J. Weisdorf

    Research output: Contribution to journalArticle

    38 Citations (Scopus)

    Abstract

    The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.

    Original languageEnglish (US)
    Pages (from-to)185-192
    Number of pages8
    JournalHaematologica
    Volume98
    Issue number2
    DOIs
    StatePublished - Feb 1 2013

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    Cell Transplantation
    Acute Myeloid Leukemia
    Registries
    Siblings
    Blood Cells
    Transplantation
    Bone Marrow
    Research
    Transplants
    Mortality
    Recurrence
    Survival
    Therapeutics
    Incidence
    Leukemia
    Tissue Donors
    Homologous Transplantation
    Treatment Failure
    Multivariate Analysis
    Survival Rate

    ASJC Scopus subject areas

    • Hematology
    • Medicine(all)

    Cite this

    Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission : A registry study from the center for international blood and marrow transplantation research. / Keating, Armand; DaSilva, Gisela; Pérez, Waleska S.; Gupta, Vikas; Cutler, Corey S.; Ballen, Karen K.; Cairo, Mitchell S.; Camitta, Bruce M.; Champlin, Richard E.; Gajewski, James L.; Lazarus, Hillard M.; Lill, Michael; Marks, David I.; Nabhan, Chadi; Schiller, Gary J.; Socie, Gerald; Szer, Jeffrey; Tallman, Martin S.; Weisdorf, Daniel J.

    In: Haematologica, Vol. 98, No. 2, 01.02.2013, p. 185-192.

    Research output: Contribution to journalArticle

    Keating, A, DaSilva, G, Pérez, WS, Gupta, V, Cutler, CS, Ballen, KK, Cairo, MS, Camitta, BM, Champlin, RE, Gajewski, JL, Lazarus, HM, Lill, M, Marks, DI, Nabhan, C, Schiller, GJ, Socie, G, Szer, J, Tallman, MS & Weisdorf, DJ 2013, 'Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: A registry study from the center for international blood and marrow transplantation research', Haematologica, vol. 98, no. 2, pp. 185-192. https://doi.org/10.3324/haematol.2012.062059
    Keating, Armand ; DaSilva, Gisela ; Pérez, Waleska S. ; Gupta, Vikas ; Cutler, Corey S. ; Ballen, Karen K. ; Cairo, Mitchell S. ; Camitta, Bruce M. ; Champlin, Richard E. ; Gajewski, James L. ; Lazarus, Hillard M. ; Lill, Michael ; Marks, David I. ; Nabhan, Chadi ; Schiller, Gary J. ; Socie, Gerald ; Szer, Jeffrey ; Tallman, Martin S. ; Weisdorf, Daniel J. / Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission : A registry study from the center for international blood and marrow transplantation research. In: Haematologica. 2013 ; Vol. 98, No. 2. pp. 185-192.
    @article{54c040ece9ba422a88cb4d3a8c6508e1,
    title = "Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: A registry study from the center for international blood and marrow transplantation research",
    abstract = "The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20{\%}. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19{\%} (95{\%} confidence interval, 16-23{\%}), 20{\%} (17-24{\%}) and 8{\%} (5-12{\%}) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20{\%} (17-24{\%}), 26{\%} (21-30{\%}) and 45{\%} (38-52{\%}), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61{\%} (56-65{\%}) and 64{\%} (59-68{\%}); allogeneic peripheral blood 54{\%} (49-59{\%}) and 59{\%} (54-64{\%}); autologous peripheral blood 47{\%} (40-54{\%}) and 54{\%} (47-60{\%}); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.",
    author = "Armand Keating and Gisela DaSilva and P{\'e}rez, {Waleska S.} and Vikas Gupta and Cutler, {Corey S.} and Ballen, {Karen K.} and Cairo, {Mitchell S.} and Camitta, {Bruce M.} and Champlin, {Richard E.} and Gajewski, {James L.} and Lazarus, {Hillard M.} and Michael Lill and Marks, {David I.} and Chadi Nabhan and Schiller, {Gary J.} and Gerald Socie and Jeffrey Szer and Tallman, {Martin S.} and Weisdorf, {Daniel J.}",
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    T1 - Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission

    T2 - A registry study from the center for international blood and marrow transplantation research

    AU - Keating, Armand

    AU - DaSilva, Gisela

    AU - Pérez, Waleska S.

    AU - Gupta, Vikas

    AU - Cutler, Corey S.

    AU - Ballen, Karen K.

    AU - Cairo, Mitchell S.

    AU - Camitta, Bruce M.

    AU - Champlin, Richard E.

    AU - Gajewski, James L.

    AU - Lazarus, Hillard M.

    AU - Lill, Michael

    AU - Marks, David I.

    AU - Nabhan, Chadi

    AU - Schiller, Gary J.

    AU - Socie, Gerald

    AU - Szer, Jeffrey

    AU - Tallman, Martin S.

    AU - Weisdorf, Daniel J.

    PY - 2013/2/1

    Y1 - 2013/2/1

    N2 - The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.

    AB - The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.

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