Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study

Celalettin Ustun, Jennifer Le-Rademacher, Hai Lin Wang, Megan Othus, Zhuoxin Sun, Brittny Major, Mei Jie Zhang, Elizabeth Storrick, Jacqueline M. Lafky, Selina Chow, Krzysztof Mrózek, Eyal C. Attar, Such Nand, Clara D. Bloomfield, Larry D. Cripe, Martin S. Tallman, Frederick Appelbaum, Richard A. Larson, Guido Marcucci, Gail J. RobozGeoffrey L. Uy, Richard M. Stone, Aminah Jatoi, Thomas C. Shea, Marcos de Lima, James M Foran, Brenda M. Sandmaier, Mark R Litzow, Harry P. Erba, Arti Hurria, Daniel J. Weisdorf, Andrew S. Artz

Research output: Contribution to journalArticle

Abstract

The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60–77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5–5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29–0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24–34%) versus CT 13.8% (9–21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.

Original languageEnglish (US)
JournalLeukemia
DOIs
StatePublished - Jan 1 2019

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Consolidation Chemotherapy
Cell Transplantation
Acute Myeloid Leukemia
Drug Therapy
Survival
Mortality
Recurrence
Induction Chemotherapy
Therapeutics
Cytogenetics
Multicenter Studies
Retrospective Studies
Clinical Trials

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1) : an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. / Ustun, Celalettin; Le-Rademacher, Jennifer; Wang, Hai Lin; Othus, Megan; Sun, Zhuoxin; Major, Brittny; Zhang, Mei Jie; Storrick, Elizabeth; Lafky, Jacqueline M.; Chow, Selina; Mrózek, Krzysztof; Attar, Eyal C.; Nand, Such; Bloomfield, Clara D.; Cripe, Larry D.; Tallman, Martin S.; Appelbaum, Frederick; Larson, Richard A.; Marcucci, Guido; Roboz, Gail J.; Uy, Geoffrey L.; Stone, Richard M.; Jatoi, Aminah; Shea, Thomas C.; de Lima, Marcos; Foran, James M; Sandmaier, Brenda M.; Litzow, Mark R; Erba, Harry P.; Hurria, Arti; Weisdorf, Daniel J.; Artz, Andrew S.

In: Leukemia, 01.01.2019.

Research output: Contribution to journalArticle

Ustun, C, Le-Rademacher, J, Wang, HL, Othus, M, Sun, Z, Major, B, Zhang, MJ, Storrick, E, Lafky, JM, Chow, S, Mrózek, K, Attar, EC, Nand, S, Bloomfield, CD, Cripe, LD, Tallman, MS, Appelbaum, F, Larson, RA, Marcucci, G, Roboz, GJ, Uy, GL, Stone, RM, Jatoi, A, Shea, TC, de Lima, M, Foran, JM, Sandmaier, BM, Litzow, MR, Erba, HP, Hurria, A, Weisdorf, DJ & Artz, AS 2019, 'Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study', Leukemia. https://doi.org/10.1038/s41375-019-0477-x
Ustun, Celalettin ; Le-Rademacher, Jennifer ; Wang, Hai Lin ; Othus, Megan ; Sun, Zhuoxin ; Major, Brittny ; Zhang, Mei Jie ; Storrick, Elizabeth ; Lafky, Jacqueline M. ; Chow, Selina ; Mrózek, Krzysztof ; Attar, Eyal C. ; Nand, Such ; Bloomfield, Clara D. ; Cripe, Larry D. ; Tallman, Martin S. ; Appelbaum, Frederick ; Larson, Richard A. ; Marcucci, Guido ; Roboz, Gail J. ; Uy, Geoffrey L. ; Stone, Richard M. ; Jatoi, Aminah ; Shea, Thomas C. ; de Lima, Marcos ; Foran, James M ; Sandmaier, Brenda M. ; Litzow, Mark R ; Erba, Harry P. ; Hurria, Arti ; Weisdorf, Daniel J. ; Artz, Andrew S. / Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1) : an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. In: Leukemia. 2019.
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abstract = "The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60–77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95{\%} CI: 1.5–5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95{\%} CI: 0.29–0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29{\%} (24–34{\%}) versus CT 13.8{\%} (9–21{\%}) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.",
author = "Celalettin Ustun and Jennifer Le-Rademacher and Wang, {Hai Lin} and Megan Othus and Zhuoxin Sun and Brittny Major and Zhang, {Mei Jie} and Elizabeth Storrick and Lafky, {Jacqueline M.} and Selina Chow and Krzysztof Mr{\'o}zek and Attar, {Eyal C.} and Such Nand and Bloomfield, {Clara D.} and Cripe, {Larry D.} and Tallman, {Martin S.} and Frederick Appelbaum and Larson, {Richard A.} and Guido Marcucci and Roboz, {Gail J.} and Uy, {Geoffrey L.} and Stone, {Richard M.} and Aminah Jatoi and Shea, {Thomas C.} and {de Lima}, Marcos and Foran, {James M} and Sandmaier, {Brenda M.} and Litzow, {Mark R} and Erba, {Harry P.} and Arti Hurria and Weisdorf, {Daniel J.} and Artz, {Andrew S.}",
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T1 - Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1)

T2 - an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study

AU - Ustun, Celalettin

AU - Le-Rademacher, Jennifer

AU - Wang, Hai Lin

AU - Othus, Megan

AU - Sun, Zhuoxin

AU - Major, Brittny

AU - Zhang, Mei Jie

AU - Storrick, Elizabeth

AU - Lafky, Jacqueline M.

AU - Chow, Selina

AU - Mrózek, Krzysztof

AU - Attar, Eyal C.

AU - Nand, Such

AU - Bloomfield, Clara D.

AU - Cripe, Larry D.

AU - Tallman, Martin S.

AU - Appelbaum, Frederick

AU - Larson, Richard A.

AU - Marcucci, Guido

AU - Roboz, Gail J.

AU - Uy, Geoffrey L.

AU - Stone, Richard M.

AU - Jatoi, Aminah

AU - Shea, Thomas C.

AU - de Lima, Marcos

AU - Foran, James M

AU - Sandmaier, Brenda M.

AU - Litzow, Mark R

AU - Erba, Harry P.

AU - Hurria, Arti

AU - Weisdorf, Daniel J.

AU - Artz, Andrew S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60–77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5–5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29–0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24–34%) versus CT 13.8% (9–21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.

AB - The preferred post-remission therapy for older patients with acute myeloid leukemia (AML) in first complete remission (CR1) remains uncertain. In this retrospective, multicenter study, we compared the outcomes for older AML patients (age 60–77 years) receiving allogeneic hematopoietic cell transplantation (alloHCT) (n = 431) with those treated on prospective National Clinical Trials Network induction and nontransplantation chemotherapy (CT) consolidation trials (n = 211). AlloHCT patients were younger (median age: 64.2 versus 67.9 years, p < 0.001), but more frequently had high-risk AML (high WBC, secondary AML, and unfavorable cytogenetics). Overall survival (OS) was worse in alloHCT during the first 9 months after CR1 (HR = 1.52, p = 0.02), but was significantly better thereafter (HR = 0.53, p < 0.0001) relative to CT. Treatment-related mortality (TRM) following HCT was worse in the first 9 months (HR = 2.8, 95% CI: 1.5–5.2, p = 0.0009), while post-HCT relapse was significantly less frequent beyond 9 months (HR = 0.42, 95% CI: 0.29–0.61, p < 0.0001). Despite higher early TRM, alloHCT recipients had superior long-term OS [29% (24–34%) versus CT 13.8% (9–21%) at 5 years]. Although this is a retrospective analysis with potential biases, it indicates that alloHCT led to heightened early risks from TRM, yet reduced relapse and superior long-term survival relative to CT in older AML patients in CR1.

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