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.