Allogeneic HCT May Not Significantly Benefit Some Patients With AML After First Remission

Allogeneic hematopoietic cell transplantation (HCT) during first complete remission was not linked with superior overall survival compared with consolidation chemotherapy in patients 60 years or younger with intermediate-risk acute myeloid leukemia (AML) during the first complete remission and an available donor, according to recent study results.

In particular, allogeneic HCT is a procedure when a patient receives stem cells, or healthy blood-forming cells, from a donor to replace their own cells that were destroyed by high doses of chemotherapy or radiation treatment. Consolidation chemotherapy is treatment given after cancer has disappeared from initial therapy. This tactic, which may also be called post-remission therapy, is used to kill any remaining cancer cells in the body.

The likelihood of achieving a first complete remission (the disappearance of all signs of cancer from treatment) in patients with AML is dependent of molecular risk factors, and 50% to 70% of patients are referred to post-remission therapy to reduce the risk of recurrence, according to the introduction of the study published in JAMA Oncology. And patients with a favorable risk derive a greater benefit from consolidation chemotherapy, whereas high-risk patients typically benefit from allogeneic HCT.

But there is controversy as to what therapy may be best for the intermediate-risk group, according to the researchers. So the purpose of this study was to better understand what therapy is optimal for patients with immediate-risk AML aged 60 years or younger after first complete remission.

Researchers conducting the study included 143 patients who received either allogeneic HCT (76 patients) or high-dose cytarabine for consolidation chemotherapy and salvage HCT only if they relapsed (67 patients).

The probability of survival at two years was 74% after primary allogeneic HCT compared with 84% after consolidation chemotherapy. Disease-free survival (the measure of time after treatment during which no sign of cancer is found) after two years was 69% with HCT and 40% with consolidation chemotherapy.

At two years, allogeneic HCT during the first complete remission was associated with a 20% incidence of relapse compared with 58% with consolidation chemotherapy.

Non-relapse mortality (any death not preceded by relapse) at two years was 9% after patients underwent allogeneic HCT and 2% in those who underwent consolidation chemotherapy. The study authors called this an “important and rewarding finding.” Of note, the 41 patients who relapsed after consolidation chemotherapy later underwent allogeneic HCT.

Notably, there were no significant differences in health-related quality of life measures between groups.

Additionally, the duration of hospitalization was significantly longer for patients in the consolidation chemotherapy group. The researchers wrote that this finding was expected but should be taken into consideration when patients and their families are making treatment decisions.

“Although the returns of quality of life remained below our expectations, other quality-of-life outcomes, expect for temporal physical dysfunction, did not differ between the treatment groups,” they wrote. “Such a finding is of practical relevance and can be incorporated into future patient counseling.”

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