Post-remission therapy of acute myeloid leukemia in first remission

Abstract

Background: At AML in first remission, treatment-modality depends on patient's prognostic factor and donor availability. According to the risk group of AML, post remission therapy has not established. We analyzed the effect of post-remission therapy of AML in first remission, allogeneic, autologous HSCT and intensive chemotherapy. Method: According to the post-remission therapy, we retrospectively evaluated the prognostic factor, the event-free survival (EFS) and the overall survival (OS) of 122 patients with AML in first remission from 1995 to 2004. All patients received standard induction therapy. After complete remission had been achieved, consolidation therapy was started. According to patients' clinical status and donor availability, patients were offered the different treatment-modalities, allogeneic, autologous HSCT or intensive chemotherapy. Result: Twenty-five patients received allogeneic HSCT, 36 patients autologous HSCT and 61 patients intensive chemotherapy. Median age was 33 years in allogeneic HSCT group, 38 years in autologous HSCT group, and 46 years in intensive chemotherapy group. The 5-year EFS were 72% in allogeneic HSCT group, 57% in the autologous HSCT group and 50% in chemotherapy group (p=0.049). When comparing between treatment groups, there was no difference in EFS. The 5-year OS rates were 80% in allogeneic HSCT group, 60% in autologous HSCT group and 53% in chemotherapy group (p=0.02). There was a significant difference in OS only between allogeneic HSCT group and chemotherapy group (p=0.04). There was an advantage in terms of EFS (p=0.04) and OS (p=0.03) with HSCT as compared intensive chemotherapy. The EFS and OS of allogeneic HSCT as compared with autologous HSCT has not difference. There was a significant benefit for EFS and OS with HSCT group when compared to those in intensive chemotherapy group in the high risk group of AML patients (p<0.05). In the intermediate and low risk group of AML, there was no significant difference in OS with HSCT as compared to the intensive chemotherapy, but a significant benefit for EFS of HSCT as compared with the intensive chemotherapy (p<0.05). Conclusion: The treatment of high risk-AML in first remission with either allogeneic or autologous hematopoietic stem cell transplantation prolongs EFS and OS as compared with intensive chemotherapy. In the intermediate or low risk-AML, there was a significant benefit for only EFS with HSCT compared as intensive chemotherapy.