Publication details

Hematopoietic cell transplantation in patients with intermediate and high-risk AML: results from the randomized Study Alliance Leukemia (SAL) AML 2003 trial

Authors	SCHETELIG J. SCHAICH M. SCHAFER-ECKART K. HANEL M. AULITZKY W.E. EINSELE H. SCHMITZ N. ROSLER W. STELLJES M. BALDUS C.D. HO A.D. NEUBAUER A. SERVE H. MAYER Jiří BERDEL W.E. MOHR B. OELSCHLAGEL U. PARMENTIER S. ROLLIG C. KRAMER M. PLATZBECKER U. ILLMER T. THIEDE C. BORNHAUSER M. EHNINGER G.
Year of publication	2015
Type	Article in Periodical
Magazine / Source	Leukemia
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1038/leu.2014.335
Field	Oncology and hematology
Keywords	ACUTE MYELOID-LEUKEMIA; 1ST COMPLETE REMISSION; POSTREMISSION THERAPY; HEMATOLOGIC MALIGNANCIES; DONOR TRANSPLANTATION; COMPARABLE SURVIVAL; INDUCTION THERAPY; UNRELATED DONORS; CLINICAL-TRIALS; INTENSITY
Description	The optimal timing of allogeneic hematopoietic stem cell transplantation (HCT) in acute myeloid leukemia (AML) is controversial. We report on 1179 patients with a median age of 48 years who were randomized upfront. In the control arm, sibling HCT was scheduled in the first complete remission for intermediate-risk or high-risk AML and matched unrelated HCT in complex karyotype AML. In the experimental arm, matched unrelated HCT in first remission was offered also to patients with an FLT3-ITD (FMS-like tyrosine kinase 3-internal tandem duplication) allelic ratio >0.8, poor day +15 marrow blast clearance and adverse karyotypes. Further, allogeneic HCT was recommended in high-risk AML to be performed in aplasia after induction chemotherapy. In the intentto- treat (ITT) analysis, superiority of the experimental transplant strategy could not be shown with respect to overall survival (OS) or event-free survival. As-treated analyses suggest a profound effect of allogeneic HCT on OS (HR 0.73; P = 0.002) and event-free survival (HR 0.67; P < 0.001). In high-risk patients, OS was significantly improved after allogeneic HCT in aplasia (HR 0.64; P = 0.046) and after HCT in remission (HR 0.74; P = 0.03). Although superiority of one study arm could not be demonstrated in the ITT analysis, secondary analyses suggest that early allogeneic HCT is a promising strategy for patients with high-risk AML.