5 years ago

Unrelated matched versus autologous transplantation in adult patients with good and intermediate risk acute myelogenous leukemia in first molecular remission

Liisa Volin, Anne Huynh, Depei Wu, , Mohamad Mohty, Mohamed Houhou, Myriam Labopin, Arnon Nagler, Norbert-Claude Gorin, Ibrahim Yakoub-Agha, Jean Yves Cahn, Peter Remenyi, Melanie Mercier, Thomas Pabst
Patients with Acute Myelogenous Leukemia have a better outcome if reaching molecular remission. We compared the outcome of 373 patients autografted and 335 patients allografted with a 10/10 compatible unrelated donor in first molecular remission. Patients were stratified using the ELN European Leukemia Net classification. ELN favorable group: (234 auto and 70 unrelated transplants). By univariate analysis, in the auto group, the Non Relapse Mortality (NRM) was lower (3.7% versus 19%; p< 10−4), Relapse Incidence (RI) higher (29% versus 17%, p< 10−4), Leukemia Free Survival (LFS) identical (67% versus 64%) and Overall Survival (OS) better than in the allogeneic group (83% versus 62%; p=0.008). By multivariate analysis, autologous transplantation was associated with a lower NRM (HR: 4, p =0.01) and a better OS (HR: 2.08, p= 0.04). ELN intermediate group 1: (87 autologous and 172 unrelated transplants). By univariate analysis, in the auto group, NRM was lower (2.5% versus 11.8%; p= 0.03), RI higher (59% versus 18%, p< 10−6), LFS lower (39% versus 70%; p< 10−6) and OS lower than in the unrelated donor group (61% versus 74%; p=0.005). By multivariate analysis, unrelated donor was superior to autologous transplantation for LFS (HR: 0.36, p < 10−5) and OS (HR: 0.53, p= 0.01). ELN intermediate group 2: (52 autologous and 93 unrelated donors). The outcome was identical. We conclude that good risk patients get higher benefit from autologous transplantation. Intermediate risk 2 patients have the same outcome and Intermediate risk 1 patients get higher benefit from unrelated donor transplants. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/ajh.24904

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