Results of a HOVON/SAKK donor versus no-donor analysis of myeloablative HLA-identical sibling stem cell transplantation in first remission acute myeloid leukemia in young and middle-aged adults: benefits for whom?
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Cornelissen, Jan J.
Erasmus University Medical Center, Rotterdam, The Netherlands;
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van Putten, Wim L. J.
Erasmus University Medical Center, Rotterdam, The Netherlands;
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Verdonck, Leo F.
University Medical Center Utrecht, Utrecht, The Netherlands;
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Theobald, Matthias
Johannes Gutenberg University, Mainz, Germany;
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Jacky, Emanuel
University Hospital Zurich, Zurich, Switzerland;
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Daenen, Simon M. G.
University Medical Center Groningen, Groningen, The Netherlands;
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van Marwijk Kooy, Marinus
Isala Klinieken, Zwolle, The Netherlands;
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Wijermans, Pierre
Haga Hospital, Den Haag, The Netherlands;
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Schouten, Harry
University Hospital Maastricht, Maastricht, The Netherlands;
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Huijgens, Peter C.
Free University Medical Center, Amsterdam, The Netherlands;
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van der Lelie, Hans
Amsterdam Medical Center, Amsterdam, The Netherlands;
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Fey, Martin
University Hospital, Bern, Switzerland;
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Ferrant, Augustin
Cliniques Universitaires Saint-Luc, Brussels, Belgium;
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Maertens, Johan
University Hospital Gasthuisberg, Leuven, Belgium;
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Gratwohl, Alois
Kantonsspital, Basel, Switzerland
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Lowenberg, Bob
Erasmus University Medical Center, Rotterdam, The Netherlands;
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Published in:
- Blood. - American Society of Hematology. - 2007, vol. 109, no. 9, p. 3658-3666
English
Abstract
The Dutch-Belgian Hemato-Oncology Cooperative Group and the Swiss Group for Clinical Cancer Research (HOVON-SAKK) collaborative study group evaluated outcome of patients (pts) with acute myeloid leukemia (AML) in first remission (CR1) entered in 3 consecutive studies according to a donor versus no-donor comparison. Between 1987 and 2004, 2287 pts were entered in these studies of whom 1032 pts (45%) without FAB M3 or t(15;17) were in CR1 after 2 cycles of chemotherapy, received consolidation treatment, and were younger than 55 years of age and therefore eligible for allogeneic hematopoietic stem cell transplantation (allo-SCT). An HLA-identical sibling donor was available for 326 pts (32%), whereas 599 pts (58%) lacked such a donor, and information was not available in 107 pts. Compliance with allo-SCT was 82% (268 of 326). Cumulative incidences of relapse were, respectively, 32% versus 59% for pts with versus those without a donor (P < .001). Despite more treatment-related mortality (TRM) in the donor group (21% versus 4%, P < .001), disease-free survival (DFS) appeared significantly better in the donor group (48% ± 3% versus 37% ± 2% in the no-donor group, P < .001). Following risk-group analysis, DFS was significantly better for pts with a donor and an intermediate- (P = .01) or poor-risk profile (P = .003) and also better in pts younger than 40 years of age (P < .001). We evaluated our results and those of the previous MRC, BGMT, and EORTC studies in a meta-analysis, which revealed a significant benefit of 12% in overall survival (OS) by donor availability for all patients with AML in CR1 without a favorable cytogenetic profile.
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https://sonar.ch/global/documents/268072
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