International Journal of Hematology

DOI: 10.1007/s12185-017-2389-8 Pages: 1-10

Prospective randomization of post-remission therapy comparing autologous peripheral blood stem cell transplantation versus high-dose cytarabine consolidation for acute myelogenous leukemia in first remission

1. Kyushu University Graduate School of Medical Science, Department of Medicine and Biosystemic Science

2. Kurume University Hospital, Department of Hematology

3. Matsuyama Red Cross Hospital, Department of Hematology

4. Toranomon Hospital, Department of Hematology

5. Kameda Medical Center, Department of Hematology

6. Hamanomachi Hospital, Department of Hematology

7. Japan Community Health Care Organization Kyushu Hospital, Department of Hematology

8. National Kyushu Medical Center, Department of Hematology

9. Harasanshin Hospital, Department of Hematology

10. Kumamoto Medical Center, Department of Internal Medicine, National Hospital Organization

11. Hokkaido University Hospital, Department of Hematology

12. Medical Center for Karatsu-Higashimatsuura Medical Association

Correspondence to:
Toshihiro Miyamoto
Tel: 81-92-642-5230
Email: toshmiya@intmed1.med.kyushu-u.ac.jp

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Abstract

We prospectively compared outcomes of autologous stem cell transplantation (ASCT) versus high-dose cytarabine (HiDAC) consolidation as post-remission therapy for favorable- and intermediate-risk acute myelogenous leukemia (AML) in first complete remission (CR1). Two-hundred-forty patients under 65 years with AML-M1, M2, M4, or M5 subtypes were enrolled. After induction, 153 patients did not undergo randomization, while the remaining 87 who achieved CR1 were prospectively randomized to HiDAC (n = 45) or ASCT arm (n = 42). In the HiDAC arm, 43 patients completed three cycles of HiDAC, whereas in ASCT arm 22 patients completed two cycles of consolidation consisting of intermediate-dose cytarabine plus mitoxantrone or etoposide followed by ASCT. The three-year disease-free survival (DFS) rate was 41% in HiDAC and 55% in ASCT arm (p = 0.25). Three-year overall survival (OS) rates were 77 and 68% (p = 0.67). Incidence of relapse was 54 and 41% (p = 0.22). There was no significant difference in nonrelapse mortality between two arms (p = 0.88). Patients in the ASCT arm tended to have higher DFS rates and lower relapse rates than patients in HiDAC; however, there was no significant improvement in OS in patients with favorable- and intermediate-risk AML in CR1. Patients with AML are not benefited by the intensified chemotherapy represented by ASCT.

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