Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: benefits for whom?
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- Jan J. Cornelissen
- Erasmus University Medical Center, Rotterdam, The Netherlands;
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- Wim L. J. van Putten
- Erasmus University Medical Center, Rotterdam, The Netherlands;
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- Leo F. Verdonck
- University Medical Center Utrecht, Utrecht, The Netherlands;
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- Matthias Theobald
- Johannes Gutenberg University, Mainz, Germany;
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- Emanuel Jacky
- University Hospital Zurich, Zurich, Switzerland;
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- Simon M. G. Daenen
- University Medical Center Groningen, Groningen, The Netherlands;
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- Marinus van Marwijk Kooy
- Isala Klinieken, Zwolle, The Netherlands;
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- Pierre Wijermans
- Haga Hospital, Den Haag, The Netherlands;
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- Harry Schouten
- University Hospital Maastricht, Maastricht, The Netherlands;
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- Peter C. Huijgens
- Free University Medical Center, Amsterdam, The Netherlands;
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- Hans van der Lelie
- Amsterdam Medical Center, Amsterdam, The Netherlands;
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- Martin Fey
- University Hospital, Bern, Switzerland;
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- Augustin Ferrant
- Cliniques Universitaires Saint-Luc, Brussels, Belgium;
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- Johan Maertens
- University Hospital Gasthuisberg, Leuven, Belgium;
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- Alois Gratwohl
- Kantonsspital, Basel, Switzerland
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- Bob Lowenberg
- Erasmus University Medical Center, Rotterdam, The Netherlands;
抄録
<jats:title>Abstract</jats:title> <jats:p>The Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research (HOVON-SAKK) collaborative study group evaluated outcome of patients (pts) with acute myeloid leukemia (AML) in first remission (CR1) entered in 3 consecutive studies according to a donor versus no-donor comparison. Between 1987 and 2004, 2287 pts were entered in these studies of whom 1032 pts (45%) without FAB M3 or t(15;17) were in CR1 after 2 cycles of chemotherapy, received consolidation treatment, and were younger than 55 years of age and therefore eligible for allogeneic hematopoietic stem cell transplantation (allo-SCT). An HLA-identical sibling donor was available for 326 pts (32%), whereas 599 pts (58%) lacked such a donor, and information was not available in 107 pts. Compliance with allo-SCT was 82% (268 of 326). Cumulative incidences of relapse were, respectively, 32% versus 59% for pts with versus those without a donor (P < .001). Despite more treatment-related mortality (TRM) in the donor group (21% versus 4%, P < .001), disease-free survival (DFS) appeared significantly better in the donor group (48% ± 3% versus 37% ± 2% in the no-donor group, P < .001). Following risk-group analysis, DFS was significantly better for pts with a donor and an intermediate- (P = .01) or poor-risk profile (P = .003) and also better in pts younger than 40 years of age (P < .001). We evaluated our results and those of the previous MRC, BGMT, and EORTC studies in a meta-analysis, which revealed a significant benefit of 12% in overall survival (OS) by donor availability for all patients with AML in CR1 without a favorable cytogenetic profile.</jats:p>
収録刊行物
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- Blood
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Blood 109 (9), 3658-3666, 2007-01-09
American Society of Hematology