Better long-term outcomes with allo-HCT compared to chemotherapy in older patients with AML in CR1

Allogeneic hematopoietic cell transplantation (HCT) in older patients with acute myeloid leukemia (AML) in first complete remission (CR1) had higher early mortality, but reduced relapse resulted in significantly better long-term survival compared to a similar patient cohort undergoing chemotherapy consolidation.

This multi-center alliance trial conducted by SWOG, ECOG-ACRIN, and CIBMTR retrospectively compared outcomes of 431 patients with AML in CR1 who were age 60-75 years and underwent HCT with a similar patient cohort treated on prospective National Clinical Trials Network induction and non-transplantation chemotherapy consolidation trials (n=211).

Patients receiving a first allogeneic HCT between 2008 and 2013 included in the Center for International Blood and Marrow Transplant (CIBMTR) database comprised the HCT cohort. 

Median age was lower in the HCT cohort compared to the non-transplant cohort (64.2 vs. 67.9 years, respectively, p<0.001), but the HCT patients more frequently had high-risk AML (high WBC, secondary AML, and poor-risk cytogenetics). There were 110 patients age 70 or older and overall outcomes for these patients did not differ between non-HCT and HCT cohorts.

Overall survival (OS) was lower in HCT patients 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 chemotherapy consolidation. Despite higher early transplant-related mortality, HCT recipients had significantly higher 5-year OS compared to chemotherapy consolidation (28.6% vs. 13.8%, respectively, p<0.05).

The researchers suggested that “selection of treatment involves focusing on applying better geriatric performance assessment, donor selection and educating patients and families on allo-HCT.” They recommend that for older patients with AML who are fit for HCT, planning should begin soon after diagnosis with early donor identification.

Ustun C, et al. Leukemia