No Survival Benefit Found With Allogeneic Hematopoietic Cell Transplantation in Older Patients With AML

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At first glance, the data on 695 patients with advanced myeloid leukemia (AML) seem to support a survival advantage of allogeneic hematopoietic cell transplantation (HCT) compared with no transplantat
At first glance, the data on 695 patients with advanced myeloid leukemia (AML) seem to support a survival advantage of allogeneic hematopoietic cell transplantation (HCT) compared with no transplantat
The following article features coverage from the American Society of Hematology (ASH) 2018 meeting. Click here to read more of Cancer Therapy Advisor's conference coverage.

At first glance, the data on 695 patients with advanced myeloid leukemia (AML) that were presented by Mohamed L. Sorror, MD, MSc, and colleagues at the 2018 American Society of Hematology (ASH) Annual Meeting, San Diego, California, seem to support a survival advantage of allogeneic hematopoietic cell transplantation (HCT) compared with no transplantation (P = .0003) — and this benefit was seen in patients with intermediate risk, unfavorable European Leukemia Network (ELN) risk, and across a cohort with the most vulnerable patients (aged at least 60 years or with a HCT-comorbidity index [CI] scores of at least 4).1

But, after adjusting for AML- and patient-specific variables, the perceived survival benefit disappeared. “Formal tests of interactions showed no statistically compelling evidence that the association of HCT and mortality varies with respect to the timing of mortality or to the underlying ELN risk,” the authors wrote.

Survival after HCT was 58% at 2 years, and median follow-up was 16.8 months.

Despite the fact that the researchers expected to see HCT administration confer a survival benefit in patients across the 13 different referral centers, in the prospective, multicenter, longitudinal study, the researchers explained that their adjusted results could likely be the result of a few different factors: better screening and selection of patients who would be considered eligible for transplant, improvements in supportive care, advances in medications not based on HCT, and “a relatively high non-relapse mortality early after HCT and the need for longer follow-up to demonstrate an adjusted benefit of HCT.”

The researchers did not look at donor types or investigate how that information may influence outcomes among patients but are planning to do so in the future.

“We are not recommending change in standard practice...but these findings show that we may need to improve the way we deliver a transplant,” Dr Sorror said during his presentation. “New randomized clinical trials are needed that take into account the measures of geriatric health,” he concluded.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. For a complete list of disclosures, please see the original abstract.

Read more of Cancer Therapy Advisor's coverage of the ASH 2018 meeting by visiting the conference page.

Reference

  1. Sorror ML, Storer BE, Gerds AT, et al. Survival differences among patients (pts) with acute myeloid leukemia (AML) treated with allogeneic hematopoietic cell transplantation (HCT) versus non-HCT therapies: a large real-time multicenter prospective longitudinal observational study. Presented at: 2018 American Society of Hematology (ASH) Annual Meeting and Exposition; San Diego, California: December 1-4, 2018. Abstract 207.

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