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Stem cell transplantation for secondary acute myeloid leukemia: evaluation
of transplantation as initial therapy or following induction chemotherapy
JE Anderson, TA Gooley, G Schoch, C Anasetti, WI Bensinger, RA Clift, JA Hansen, JE Sanders, R Storb and FR Appelbaum
Clinical Research Division, Fred Hutchinson Cancer Research Center,
Seattle, WA 98104, USA.
The purpose of this report is to describe the results of stem cell
transplantation as initial treatment for secondary acute myeloid leukemia
(AML). Forty-six patients (median age 42 years) with secondary AML (17
therapy-related, 29 myelodysplasia-related) who had not received remission
induction chemotherapy underwent allogeneic (n = 43) or syngeneic (n = 3)
transplantation. The 5-year actuarial disease-free survival was 24.4%, and
the cumulative incidences of relapse and nonrelapse mortality were 31.3%
and 44.3%, respectively. Lower peripheral blood blast count was associated
with a lower risk of relapse (P = .05) and shorter time from AML diagnosis
to transplant was associated with a lower risk of nonrelapse mortality (P =
.02) and improved disease-free survival (P = .026). Patients with therapy-
related secondary AML tended to have lower disease-free survival (P = .16)
and a higher relapse rate (P = .16) than patients whose leukemia was not
therapy-related. The results of these 46 previously untreated patients were
compared to 20 patients (median age 36 years, 12 therapy- related, 8
myelodysplasia-related) transplanted with chemotherapy- sensitive disease
after induction chemotherapy (first complete remission [n = 6], second
complete remission [n = 3], first untreated relapse [n = 11]). We found no
statistically significant difference in outcome between these 2 groups of
patients. These results suggest that prompt transplantation should be
considered after diagnosis of secondary AML or, if possible, high-risk
myelodysplasia, particularly in patients with low peripheral blast counts.
Innovative transplant strategies are needed to reduce the high risks of
relapse and nonrelapse mortality seen in this patient population.
Volume 89,
Issue 7,
pp. 2578-2585,
04/01/1997
Copyright © 1997 by The American Society of Hematology
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