Among 3,919 patients with acute myeloid leukemia (AML) who did not undergo transplantation in first complete remission, 1,271 relapsed and 19% were successfully treated with salvage therapy, according to an analysis of three AML trials in the United Kingdom. This percentage can be improved with a transplant, except in favorable disease, the investigators concluded. “This result suggests that, for intermediate-risk patients in particular, equivalent overall survival can be achieved by delaying transplantation until after relapse, which would require many fewer transplants,” the authors of the analysis concluded in the Journal of Clinical Oncology.
Second complete remission was achieved in 642 or 55% of patients who relapsed. “This percentage varied by risk group as follows: favorable (82%), intermediate (54%), adverse (27%), and unknown (53%), which resulted in 5-year survivals of 32%, 17%, 7%, and 23%, respectively,” the researchers reported.
Among those who relapsed, 433 patients, or 67%, “received an allotransplant that delivered superior survival compared with patients who did not receive a stem-cell transplant (42% vs 16%). A more-stringent assessment of a transplant by using delayed-entry (Mantel-Byar) analysis confirmed the benefit of transplant overall and within intermediate and adverse risk groups but not the favorable subgroup,” the authors continued.
“In this study of a large number of patients did not undergo transplantation in [first complete remission], 19% of patients were alive after only receiving chemotherapy in [first complete remission], whereas only 7% survived if they relapsed after transplant,” the investigators stated. They concluded:
“The data suggest the possibility of producing the same number of survivors overall by reserving transplantation for relapse, which would require many fewer transplants and avoid the transplant-associated morbidity and extra health-related interventions. This dilemma is particularly acute for patients with intermediate- risk disease. The decision requires the support of accurate information concerning the risk of relapse and, of relevance to this study, the possibility of successful salvage treatment of a patient when relapse happens.” ■
Burnett AK, et al: J Clin Oncol 31:1293-1301, 2013.