Stem Cell Transplants and Acute Myeloid Leukaemia - EMJ

Allogeneic Haematopoietic Stem Cell Transplants and Acute Myeloid Leukaemia

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RECENT research indicates that administering intensive consolidation chemotherapy before allogeneic haematopoietic stem cell transplant does not significantly improve outcomes compared with non-intensive consolidation in older adults with acute myleoid leukaemia (AML). Allogeneic haematopoietic stem cell transplant remains the preferred curative approach for treating AML in adults.

The study found that approximately 60–70% of older patients who undergo intensive induction chemotherapy achieve complete remission. Nevertheless, there is a lack of consensus regarding the optimal consolidation treatment for elderly patients with AML in their first complete remission before allogeneic stem cell transplant.

In a retrospective study led by Yosr Hicheri, Institute Paoli-Calmettes (IPC), Marseille, France, 130 older patients (aged 60 years or older) with AML between 2007–2017 were investigated. All patients achieved their first complete remission through intensive induction therapy. Of these, 68 patients (52.3%; median age: 63 years; 79% de novo AML) received intensive consolidation chemotherapy before allogeneic stem cell transplant, while the other 62 patients (47.7%; median age: 66 years; 77% de novo AML) received non-intensive consolidation treatment.

Comparable time intervals from diagnosis to transplant and donor types were observed between the two groups. The primary efficacy measure was relapse-free survival, with a median follow-up duration of 52.2 months.

The study found no significant difference in 2-year relapse-free survival rates between the intensive and non-intensive groups (51% versus 50%). However, the 2-year relapse-free survival rates did vary significantly based on risk classification, with favourable or intermediate-risk patients showing better outcomes compared with unfavourable-risk patients (56% versus 34%; p=0.01). The results showed that there was no significant difference in 2-year non-relapse mortality rates between the two consolidation groups (27% versus 16%).

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