Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission

Martin S. Tallman, Waleska S. Pérez, Hillard M. Lazarus, Robert Peter Gale, Richard T. Maziarz, Jacob M. Rowe, David I. Marks, Jean Yves Cahn, Asad Bashey, Michael R. Bishop, Neal Christiansen, Stanley R. Frankel, Juan J. García, Osman Ilhan, Mary J. Laughlin, Jane Liesveld, Charles Linker, Mark R. Litzow, Selina Luger, Philip L. McCarthyGustavo A. Milone, Santiago Pavlovsky, Gordon L. Phillips, James A. Russell, Ruben A. Saez, Gary Schiller, Jorge Sierra, Roy S. Weiner, Axel R. Zander, Mei Jie Zhang, Armand Keating, Daniel J. Weisdorf, Mary M. Horowitz

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Controversy exists over whether pretransplantation consolidation chemotherapy affects the outcome of subsequent autotransplantation for acute myelogenous leukemia (AML). The current study was undertaken to determine the association between previous consolidation and outcome of autotransplantation for AML in first remission. Posttransplantation outcomes of 146 patients receiving no consolidation were compared with those of 244 patients receiving standard-dose (<1 gm/m2) and 249 patients receiving high-dose (1-3 gm/m2) cytarabine, using proportional hazards regression to adjust for differences in prognostic variables. One-year transplantation-related mortality was similar among the cohorts. Five-year relapse rates were 49% (95% confidence interval CI = 39%-58%) with no consolidation, 35% (95% CI = 29%-42%) with standard-dose cytarabine, and 40% (95% CI = 33%-48%) with high-dose cytarabine (P = .07). Five-year leukemia-free survival rates were 39% (95% CI = 30%-47%) with no consolidation, 53% (95% CI = 46%-60%) with standard-dose cytarabine, and 48% (95% CI = 40%-56%) with high-dose cytarabine (P = .03). Similarly, 5-year overall survival was better in those patients receiving consolidation: 42% (95% CI = 34%-51%) with no consolidation, 59% (95% CI = 52%-65%) with standard-dose cytarabine, and 54% (95% CI = 46%-61%) with high-dose cytarabine (P = .01). Although most patients received 1 or 2 cycles of consolidation, the number of courses had no detectable effect on transplantation outcome. In multivariate analysis, risks of relapse and treatment failure were lower in the patients receiving consolidation, especially among those patients receiving blood cell grafts. Outcomes with standard-dose and high-dose cytarabine were similar. Based on our findings, we recommend that patients with AML in first remission receive consolidation before undergoing autotransplantation.

Original languageEnglish (US)
Pages (from-to)204-216
Number of pages13
JournalBiology of Blood and Marrow Transplantation
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2006

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Keywords

  • Acute myelogenous leukemia
  • Autologous
  • Autotransplantation
  • Consolidation
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Tallman, M. S., Pérez, W. S., Lazarus, H. M., Gale, R. P., Maziarz, R. T., Rowe, J. M., Marks, D. I., Cahn, J. Y., Bashey, A., Bishop, M. R., Christiansen, N., Frankel, S. R., García, J. J., Ilhan, O., Laughlin, M. J., Liesveld, J., Linker, C., Litzow, M. R., Luger, S., ... Horowitz, M. M. (2006). Pretransplantation consolidation chemotherapy decreases leukemia relapse after autologous blood and bone marrow transplants for acute myelogenous leukemia in first remission. Biology of Blood and Marrow Transplantation, 12(2), 204-216. https://doi.org/10.1016/j.bbmt.2005.10.013