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

By 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 Cahn, Martin 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 and Mark R Litzow

Abstract

International audienceThe 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

Topics: [ SDV.IMM.II ] Life Sciences [q-bio]/Immunology/Innate immunity
Publisher: Elsevier
Year: 2014
DOI identifier: 10.1016/j.bbmt.2013.10.023
OAI identifier: oai:HAL:hal-00979450v1
Provided by: Hal-Diderot
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