Study Assesses Frequency of Allogeneic Hematopoietic Cell Transplantation in Patients With AML in First Complete Remission
In a study reported in Journal of Clinical Oncology, Raya Mawad, MD, of Fred Hutchinson Cancer Research Center, and colleagues assessed the frequency of allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia (AML) in first complete remission at their institution and the reasons for not undergoing transplantation. They found that 67% of patients received hematopoietic cell transplantation and that the most common reasons for not receiving transplantation were early relapse and poor performance status.
Between January 1, 2008, and March 1, 2011, 212 newly diagnosed patients with AML received treatment at Fred Hutchinson Cancer Research Center. Complete remission was achieved in 95 patients aged < 75 years with intermediate- or high-risk disease, and 21 achieved morphologic remission with incomplete blood count recovery.
Frequency of Hematopoietic Cell Transplantation
In total, 78 (67%) of these 116 patients received hematopoietic cell transplantation at a median of 2.8 months (range, 0.5–19 months) from the date of first complete remission. The median age was 57 years in both the hematopoietic cell transplantation group (range, 18–75 years) and the nontransplantation group (range, 24–70 years; P = .514), mean Eastern Cooperative Oncology Group performance status was 1.1 vs 1.5 (P = .005), and average hematopoietic cell transplantation comorbidity score within 60 days of first complete remission was 1.7 vs 2.1 (P = .68). Of the 38 patients not receiving hematopoietic cell transplantation, 29 (76%) were HLA typed, and matched donors were found for 13 (34% of all nontransplantation patients). Only 2 (5%) patients in this group received hematopoietic cell transplantation beyond first complete remission after achieving second remission.
Reasons for No Hematopoietic Cell Transplantation
The most common causes for patients not receiving hematopoietic cell transplantation in first remission were relapse within 6 months in 12 patients (32%), poor performance status in 8 (21%), and physician decision in 5 (13%). Although 25 non–hematopoietic cell transplantation patients had no donor, this was primarily due to the cessation of donor searches as a result of other patient factors, such as relapse or decline in performance status. Lack of an available donor was not the primary reason cited for not receiving transplantation for any of the nontransplantation patients.
Relapse after first complete remission occurred in 19 (50%) of the nontransplantation patients at a median of 120 days (range, 28–361 days). In 12 of these patients, relapse occurred before planned transplantation and was cited as the reason for not receiving hematopoietic cell transplantation. An additional five patients died without confirmed evidence of relapse after first complete remission; three were considered unfit for hematopoietic cell transplantation due to concurrent medical or social issues, one deferred transplantation as a personal preference, and one was lost to follow-up.
The investigators concluded: “[Hematopoietic cell transplantation] can be performed in [first complete remission] in the majority of patients with AML for whom it is currently recommended. The main barriers to [hematopoietic cell transplantation] were early relapse and poor performance status, highlighting the need for improved therapies for patients with AML of all ages.”
The study was supported by the National Institutes of Health and the Frederick Kullman Memorial Fund.
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