Related Experiment Videos
Chemotherapy versus transplants for acute myelogenous leukemia in second remission
R P Gale1, M M Horowitz, J K Rees
1Salick Health Care, Inc., Division of Bone Marrow and Stem Cell Transplantation, Los Angeles, CA, USA.
Leukemia
|January 1, 1996
Summary
For acute myelogenous leukemia (AML) patients in second remission, HLA-identical sibling bone marrow transplants offer better leukemia-free survival (LFS) than chemotherapy for select patient groups. Further research is needed to determine optimal treatment strategies for all AML patients in second remission.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- The optimal treatment for acute myelogenous leukemia (AML) in second remission remains uncertain.
- Bone marrow transplantation from HLA-identical siblings is a potential alternative to chemotherapy, but its superiority is debated.
- Previous studies have yielded controversial results regarding the efficacy of transplantation versus chemotherapy in this patient population.
Purpose of the Study:
- To compare the 3-year leukemia-free survival (LFS) rates between chemotherapy and HLA-identical sibling bone marrow transplantation in patients with AML in second remission.
- To identify patient subgroups who may benefit more from transplantation compared to chemotherapy.
- To analyze treatment-related mortality and leukemia relapse probabilities associated with each treatment modality.
Main Methods:
- A cohort study involving 485 patients with AML in second remission.
- Patients were divided into chemotherapy (n=244) and transplant (n=257) groups, with comparable age and treatment year.
- Subgroup analyses were performed based on age (<=30 vs >30 years) and first remission duration (<=1 year vs >1 year).
Main Results:
- Three-year treatment-related mortality was significantly higher with transplantation (56%) compared to chemotherapy (7%).
- Three-year leukemia relapse probabilities were lower with transplantation (41%) versus chemotherapy (81%).
- Overall three-year LFS was higher with transplantation (26%) than chemotherapy (17%). Significantly higher LFS with transplants was observed in younger patients with longer first remissions and older patients with shorter first remissions.
Conclusions:
- HLA-identical sibling bone marrow transplantation demonstrates superior leukemia-free survival compared to chemotherapy in specific subgroups of AML patients in second remission.
- Transplantation is associated with higher treatment-related mortality but significantly lower relapse rates.
- These findings suggest that allogeneic stem cell transplantation should be considered for eligible patients with AML in second remission, particularly those in specific age and remission duration strata.