Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission

Erica D. Warlick, Kristjan Paulson, Ruta Brazauskas, Xiaobo Zhong, Alan M. Miller, Bruce M. Camitta, Biju George, Bipin N. Savani, Celalettin Ustun, David I. Marks, Edmund K. Waller, Frédéric Baron, César O. Freytes, Gérard Socie, Gorgun Akpek, Harry C. Schouten, Hillard M. Lazarus, Edwin M. Horwitz, John Koreth, Jean Yves CahnMartin Bornhauser, Matthew Seftel, Mitchell S. Cairo, Mary J. Laughlin, Mitchell Sabloff, Olle Ringdén, Robert Peter Gale, Rammurti T. Kamble, Ravi Vij, Usama Gergis, Vikram Mathews, Wael Saber, Yi Bin Chen, Jane L. Liesveld, Corey S. Cutler, Armin Ghobadi, Geoffrey L. Uy, Mary Eapen, Daniel J. Weisdorf, Mark R. Litzow

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P= 16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P= 15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P= 80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number2
DOIs
StatePublished - Feb 2014

Keywords

  • AML
  • Cytarabine consolidation
  • RIC

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Warlick, E. D., Paulson, K., Brazauskas, R., Zhong, X., Miller, A. M., Camitta, B. M., George, B., Savani, B. N., Ustun, C., Marks, D. I., Waller, E. K., Baron, F., Freytes, C. O., Socie, G., Akpek, G., Schouten, H. C., Lazarus, H. M., Horwitz, E. M., Koreth, J., ... Litzow, M. R. (2014). Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission. Biology of Blood and Marrow Transplantation, 20(2), 202-208. https://doi.org/10.1016/j.bbmt.2013.10.023