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Blood, 15 August 2000, Vol. 96, No. 4, pp. 1254-1258
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Effect of postremission chemotherapy before human
leukocyte antigen-identical sibling transplantation for acute
myelogenous leukemia in first complete remission
Martin S. Tallman,
Philip
A. Rowlings,
Gustavo Milone,
Mei-Jie Zhang,
Waleska S. Perez,
Daniel Weisdorf,
Armand Keating,
Robert Peter Gale,
Robert B. Geller,
Mary J. Laughlin,
Hillard M. Lazarus,
Selina M. Luger,
Philip L. McCarthy,
Jacob M. Rowe,
Ruben A. Saez,
Marcus R. Vowels, and
Mary M. Horowitz
From the Acute Leukemia Working Committee of the
International Bone Marrow Transplant Registry, Health Policy Institute,
Medical College of Wisconsin, Milwaukee, WI; Northwestern University
Medical School, Robert H. Lurie Comprehensive Cancer Center, Chicago,
IL; Department of Haematology, Prince of Wales Hospital, and Department
of Haematology and Oncology, Sydney Children's Hospital, Randwick,
Sydney, Australia; Fundaleu, Buenos Aires, Argentina;
Division of Hematology Oncology and Bone Marrow Transplantation,
University of Minnesota Cancer Center, Minneapolis, MN; Princess
Margaret Hospital, Toronto, Canada; Blood and Marrow
Transplant Program, Saint Luke's Hospital of Kansas City, Kansas City,
MO; Department of Hematology/Oncology, Case Western Reserve University,
Cleveland, OH; Hematology/Oncology Division, Hospital of the University
of Pennsylvania, Philadelphia, PA; Department of Medicine, Roswell Park
Cancer Institute, Buffalo, NY; Department of Hematology, Rambam Medical
Center, Haifa, Israel; Division of Bone Marrow Transplantation, Harris
Methodist Hospital, Fort Worth, TX.
Allogeneic bone marrow transplantation is an effective
postremission strategy for patients with acute myelogenous leukemia (AML) in first complete remission (CR). The value of administering consolidation chemotherapy before human leukocyte antigen
(HLA)-identical sibling transplantation is not established. Outcomes
of patients with AML in first CR receiving no consolidation therapy,
standard-dose cytarabine consolidation therapy, and high-dose
cytarabine consolidation therapy before HLA-identical sibling
transplantation were compared. Five-year treatment-related mortality
rates were 30% (95% confidence interval [CI], 18% to 42%) in
patients receiving no consolidation chemotherapy, 22% (95% CI, 17%
to 28%) in those receiving standard-dose cytarabine consolidation, and
24% (95% CI, 17% to 31%) in those receiving high-dose cytarabine
(P = NS). Five-year cumulative incidences of relapse were
19% (10% to 30%), 21% (16% to 27%), and 17% (11% to
24%), respectively (P = NS). Five-year probabilities of
leukemia-free survival were 50% (36% to 63%), 56% (49% to 63%), and 59% (50% to 66%), respectively (P = NS). Five-year
probabilities of overall survival were 60% (46% to 71%), 56% (49%
to 63%), and 60% (51% to 67%), respectively (P = NS).
The data indicate that postremission consolidation with cytarabine
before allogeneic transplantation for AML in first CR is not associated
with improved outcome compared to proceeding directly to
transplantation after successful induction.
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