Allogeneic stem cell transplantation during first complete remission improves relapse-free and overall survival in patients with intermediate and poor-risk acute myeloid leukemia (AML), according to the results of a study published in the Journal of the American Medical Association.
Acute myeloid leukemia (AML) is a cancer of the bone marrow and blood characterized by the rapid, uncontrolled growth of immature white blood cells known as myelocytes.
Treatment of AML often begins with induction therapy (initial treatment) that includes chemotherapy to produce a complete remission (defined as the disappearance of leukemia cells in the bone marrow and normalization of the white blood cell, red blood cell, and platelet levels). After induction therapy, patients generally receive additional treatment (consolidation therapy) to reduce the likelihood of leukemia recurrence.
Allogeneic stem cell transplantation is an aggressive form of treatment that involves high doses of chemotherapy, followed by infusion of donor stem cells. High doses of therapy kill more cancer cells than standard doses; however they can also deplete blood cells and put patients at risk for life-threatening infections. The infusion of stem cells after the high-dose therapy reduces the risk for infection.
Researchers are still unclear regarding the optimal treatment of AML in first complete remission. Researchers recently performed a systematic review and analysis of 24 clinical trials in which patients with AML in first complete remission underwent allogeneic stem cell transplantation, autologous stem cell transplantation, or intensive chemotherapy consolidation. Overall, the studies included 6,007 patients, 3,638 of whom were analyzed by cytogenetic risk: 547 good-risk, 2,499 intermediate-risk, and 592 poor-risk.
The results indicated the following:
Patients with poor-risk AML who underwent allogeneic stem cell transplantation had a 31% improvement in relapse-free survival (RFS) and a 27% improvement in overall survival (OS) compared with non-transplant patients.
Patients with intermediate-risk AML who underwent allogeneic stem cell transplantation had a 24% improvement in RFS and a 17% improvement in OS compared with non-transplant patients.
Patients with good-risk AML who underwent transplantation had a 6% worse RFS and a 7% worse OS compared with non-transplant patients.
The researchers concluded that allogeneic stem cell transplant has a significant survival benefit for intermediate and poor-risk AML in first complete remission but not for good-risk AML.
 Koreth J, Schlenk R, Kopecky KJ, et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission. Journal of the American Medical Association. 2009; 301: 2349-2361.
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