HLA-Identical Sibling Allogeneic Transplants versus Chemotherapy in Acute Myelogenous Leukemia with t(8;21) in First Complete Remission

Collaborative Study between the German AML Intergroup and CIBMTR

Richard F. Schlenk, Marcelo C. Pasquini, Waleska S. Pérez, Mei Jie Zhang, Jürgen Krauter, Joseph H. Antin, Asad Bashey, Brian J. Bolwell, Thomas Büchner, Jean Yves Cahn, Mitchell S. Cairo, Edward A. Copelan, Corey S. Cutler, Hartmut Döhner, Robert Peter Gale, Osman Ilhan, Hillard M. Lazarus, Jane L. Liesveld, Mark R. Litzow, David I. Marks & 8 others Richard Maziarz, Philip L. McCarthy, Stephen D. Nimer, Jorge Sierra, Martin S. Tallman, Daniel J. Weisdorf, Mary M. Horowitz, Arnold Ganser

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95% confidence interval [CI] 2.95-15.45, P <.001), lower relapse (RR 0.47, 95% CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 × 109/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT.

Original languageEnglish (US)
Pages (from-to)187-196
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume14
Issue number2
DOIs
StatePublished - Feb 2008

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Cell Transplantation
Acute Myeloid Leukemia
Siblings
Transplants
Drug Therapy
Recurrence
Proportional Hazards Models
Multicenter Studies
Survival Rate
Bone Marrow
Confidence Intervals
Survival
Mortality
Therapeutics
Research

Keywords

  • AML
  • Chemotherapy
  • Hematopoietic stem cell transplantation
  • t(8;21)

ASJC Scopus subject areas

  • Transplantation

Cite this

HLA-Identical Sibling Allogeneic Transplants versus Chemotherapy in Acute Myelogenous Leukemia with t(8;21) in First Complete Remission : Collaborative Study between the German AML Intergroup and CIBMTR. / Schlenk, Richard F.; Pasquini, Marcelo C.; Pérez, Waleska S.; Zhang, Mei Jie; Krauter, Jürgen; Antin, Joseph H.; Bashey, Asad; Bolwell, Brian J.; Büchner, Thomas; Cahn, Jean Yves; Cairo, Mitchell S.; Copelan, Edward A.; Cutler, Corey S.; Döhner, Hartmut; Gale, Robert Peter; Ilhan, Osman; Lazarus, Hillard M.; Liesveld, Jane L.; Litzow, Mark R.; Marks, David I.; Maziarz, Richard; McCarthy, Philip L.; Nimer, Stephen D.; Sierra, Jorge; Tallman, Martin S.; Weisdorf, Daniel J.; Horowitz, Mary M.; Ganser, Arnold.

In: Biology of Blood and Marrow Transplantation, Vol. 14, No. 2, 02.2008, p. 187-196.

Research output: Contribution to journalArticle

Schlenk, RF, Pasquini, MC, Pérez, WS, Zhang, MJ, Krauter, J, Antin, JH, Bashey, A, Bolwell, BJ, Büchner, T, Cahn, JY, Cairo, MS, Copelan, EA, Cutler, CS, Döhner, H, Gale, RP, Ilhan, O, Lazarus, HM, Liesveld, JL, Litzow, MR, Marks, DI, Maziarz, R, McCarthy, PL, Nimer, SD, Sierra, J, Tallman, MS, Weisdorf, DJ, Horowitz, MM & Ganser, A 2008, 'HLA-Identical Sibling Allogeneic Transplants versus Chemotherapy in Acute Myelogenous Leukemia with t(8;21) in First Complete Remission: Collaborative Study between the German AML Intergroup and CIBMTR', Biology of Blood and Marrow Transplantation, vol. 14, no. 2, pp. 187-196. https://doi.org/10.1016/j.bbmt.2007.10.006
Schlenk, Richard F. ; Pasquini, Marcelo C. ; Pérez, Waleska S. ; Zhang, Mei Jie ; Krauter, Jürgen ; Antin, Joseph H. ; Bashey, Asad ; Bolwell, Brian J. ; Büchner, Thomas ; Cahn, Jean Yves ; Cairo, Mitchell S. ; Copelan, Edward A. ; Cutler, Corey S. ; Döhner, Hartmut ; Gale, Robert Peter ; Ilhan, Osman ; Lazarus, Hillard M. ; Liesveld, Jane L. ; Litzow, Mark R. ; Marks, David I. ; Maziarz, Richard ; McCarthy, Philip L. ; Nimer, Stephen D. ; Sierra, Jorge ; Tallman, Martin S. ; Weisdorf, Daniel J. ; Horowitz, Mary M. ; Ganser, Arnold. / HLA-Identical Sibling Allogeneic Transplants versus Chemotherapy in Acute Myelogenous Leukemia with t(8;21) in First Complete Remission : Collaborative Study between the German AML Intergroup and CIBMTR. In: Biology of Blood and Marrow Transplantation. 2008 ; Vol. 14, No. 2. pp. 187-196.
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abstract = "We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95{\%} confidence interval [CI] 2.95-15.45, P <.001), lower relapse (RR 0.47, 95{\%} CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 × 109/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT.",
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AU - Gale, Robert Peter

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AU - Lazarus, Hillard M.

AU - Liesveld, Jane L.

AU - Litzow, Mark R.

AU - Marks, David I.

AU - Maziarz, Richard

AU - McCarthy, Philip L.

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