Allogeneic HSCT May Be Preferred in Certain Older Patients with Acute Leukemia
Allogeneic hematopoietic stem cell transplantation might be preferred in older patients with acute myeloid leukemia.
Allogeneic hematopoietic stem cell transplantation (HSCT) might be the preferred treatment approach in patients 60 years of age and older with intermediate- and adverse-risk acute myeloid leukemia (AML) in first complete remission, an analysis of 4 prospective AML studies published in the journal The Lancet Haematology has shown.1
For this time-dependent analysis, researchers sought to compare allogeneic HSCT with other strategies, including no post-remission therapy, in patients 60 years or older with AML.
Oftentimes, no post-remission therapy is given to older patients, but some do receive chemotherapy or allogeneic HSCT following reduced-intensity conditioning.
The investigators analyzed data from 1,155 patients included in 4 HOVON-SAKK AML trials. Of those, 640 achieved a first complete remission after induction chemotherapy. Post-remission therapy included allogeneic HSCT following reduced-intensity conditioning, gemtuzumab ozogamicin, chemotherapy, autologous HSCT, or no treatment.
Results showed that 5-year overall survival was 35% (95% CI: 25 to 44) for patients who received allogenic HSCT, 21% (95% CI: 17 to 26) for those who received no further treatment, and 26% (95% CI: 19 to 33) for those who received additional chemotherapy or autologous HSCT.
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Researchers found that allogeneic HSCT was associated with improved 5-year overall survival compared with non-allogeneic HSCT post-remission therapies or no post-remission therapy (HR=0.71; 95% CI: 0.53 to 0.95; P=0.017), particularly in patients with intermediate-risk or adverse-risk AML.
The authors noted that “the comparative value should ideally be shown in a prospective randomized study.”
- Versluis J, Hazenberg CL, Passweg JR, et al. Post-remission treatment with allogeneic stem cell transplantation in patients aged 60 years and older with acute myeloid leukaemia: time-dependent analysis [published online ahead of print September 17, 2015]. Lancet Haematol. doi: 10.1016/S2352-3026(15)00148-9.