Biology of Blood and Marrow Transplantation
Volume 14, Issue 2 , Pages 187-196, February 2008

HLA-Identical Sibling Allogeneic Transplants versus Chemotherapy in Acute Myelogenous Leukemia with t(8;21) in First Complete Remission: Collaborative Study between the German AML Intergroup and CIBMTR

  • Richard F. Schlenk

      Affiliations

    • University of Ulm, Ulm, Germany
    • ,
  • Marcelo C. Pasquini

      Affiliations

    • Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
    • Corresponding Author InformationCorrespondence and reprint requests: Marcelo C. Pasquini, MD, MS, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 8701 Watertown Plank Road, P.O. Box 26509, Milwaukee, Wisconsin, 53226.
    • ,
  • Waleska S. Pérez

      Affiliations

    • Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
    • ,
  • Mei-Jie Zhang

      Affiliations

    • Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
    • ,
  • Jürgen Krauter

      Affiliations

    • Hannover Medical School, Hannover, Germany
    • ,
  • Joseph H. Antin

      Affiliations

    • Dana-Farber Cancer Institute, Boston, Massachusetts
    • ,
  • Asad Bashey

      Affiliations

    • BMT Group of Georgia, Atlanta, Georgia
    • ,
  • Brian J. Bolwell

      Affiliations

    • Cleveland Clinic Foundation, Cleveland, Ohio
    • ,
  • Thomas Büchner

      Affiliations

    • University of Munster, Munster, Germany
    • ,
  • Jean-Yves Cahn

      Affiliations

    • Chu-Grenoble, Grenoble, France
    • ,
  • Mitchell S. Cairo

      Affiliations

    • Columbia University Medical Center, New York, New York
    • ,
  • Edward A. Copelan

      Affiliations

    • Cleveland Clinic Foundation, Cleveland, Ohio
    • ,
  • Corey S. Cutler

      Affiliations

    • Dana-Farber Cancer Institute, Boston, Massachusetts
    • ,
  • Hartmut Döhner

      Affiliations

    • University of Ulm, Ulm, Germany
    • ,
  • Robert Peter Gale

      Affiliations

    • Center for the Advanced Studies in Leukemia, Los Angeles, California
    • ,
  • Osman Ilhan

      Affiliations

    • Ibni Sinai Hospital, Ankara, Turkey
    • ,
  • Hillard M. Lazarus

      Affiliations

    • University Hospitals of Cleveland, Cleveland, Ohio
    • ,
  • Jane L. Liesveld

      Affiliations

    • University of Rochester Medical Center, Rochester, New York
    • ,
  • Mark R. Litzow

      Affiliations

    • Mayo Clinic, Rochester, Minnesota
    • ,
  • David I. Marks

      Affiliations

    • Bristol Children's Hospital, Bristol, United Kingdom
    • ,
  • Richard T. Maziarz

      Affiliations

    • Oregon Health Sciences University, Portland, Oregon
    • ,
  • Philip L. McCarthy

      Affiliations

    • Roswell Park Cancer Institute, Buffalo, New York
    • ,
  • Stephen D. Nimer

      Affiliations

    • Memorial Sloan-Kettering Cancer Center, New York, New York
    • ,
  • Jorge Sierra

      Affiliations

    • Hospital de Sant Pau, Barcelona, Spain
    • ,
  • Martin S. Tallman

      Affiliations

    • Northwestern University, Feinberg School of Medicine, Chicago, Illinois
    • ,
  • Daniel J. Weisdorf

      Affiliations

    • University of Minnesota, Minneapolis, Minnesota
    • ,
  • Mary M. Horowitz

      Affiliations

    • Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
    • ,
  • Arnold Ganser

      Affiliations

    • Hannover Medical School, Hannover, Germany
    • ,
  • CIBMTR Acute Leukemia Working Committee

Received 14 June 2007; accepted 22 October 2007. published online 17 December 2007.

Abstract 

We studied the role of HLA-matched sibling hematopoietic cell transplantation (HCT) in treating t(8;21) acute myelogenous leukemia (AML) in first remission. Outcomes of 118 patients receiving HCT and reported to the Center for International Blood and Marrow Transplant Research were compared with 132 similar patients receiving chemotherapy selected from 8 German AML Intergroup multicenter trials. Characteristics of the cohorts were similar except that chemotherapy recipients were significantly older. To adjust for time to treatment bias, outcomes were compared using left-truncated Cox regression models. Transplants were associated with higher treatment-related mortality (TRM; relative risk [RR] 6.76, 95% confidence interval [CI] 2.95-15.45, P < .001), lower relapse (RR 0.47, 95% CI 0.25-0.85, P = .01), and similar relapse-free survival (P = .2). Loss of sex chromosomes (LOS) in addition to t(8;21) had a negative impact on overall survival (OS) in patients receiving chemotherapy. Patients without LOS experienced shorter survival after HCT comparing to chemotherapy (RR 3.05, P = .02), whereas patients with LOS had similar survival regardless of postremission therapy. In both cohorts, white blood cell count (WBC) at diagnosis >25 × 109/L was associated with a higher relapse risk (RR = 2.09, P = .03), lower relapse-free (RR = 1.9, P = .008), and OS (RR = 1.91, P = .01). In this cohort of patients with t(8;21) AML, HCT did not improve OS, because reduction of relapse was offset by high TRM. In the group without LOS, survival after chemotherapy was far superior to HCT. These results suggest that patients with t(8;21) AML without poor prognostic factors have higher rates of survival after chemotherapy as a post remission therapy compared to HCT.

Key Words: t(8;21), AML, Hematopoietic stem cell transplantation, Chemotherapy

 

 The first two authors contributed equally to this article.

PII: S1083-8791(07)00528-9

doi:10.1016/j.bbmt.2007.10.006

Biology of Blood and Marrow Transplantation
Volume 14, Issue 2 , Pages 187-196, February 2008

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