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Hematopoietic cell transplantation in patients with intermediate and high-risk AML: results from the randomized Study Alliance Leukemia (SAL) AML 2003 trial

The optimal timing of allogeneic hematopoietic stem cell transplantation (HCT) in acute myeloid leukemia (AML) is controversial. We report on 1179 patients with a median age of 48 years who were randomized upfront. In the control arm, sibling HCT was scheduled in the first complete remission for int...

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Main Authors: Schetelig, Johannes (Author) , Schaich, M. (Author) , Schäfer-Eckart, K. (Author) , Hänel, M. (Author) , Aulitzky, W. E. (Author) , Einsele, H. (Author) , Schmitz, N. (Author) , Rösler, W. (Author) , Stelljes, M. (Author) , Baldus, C. D. (Author) , Ho, Anthony Dick (Author) , Neubauer, A. (Author) , Serve, H. (Author) , Mayer, J. (Author) , Berdel, W. E. (Author) , Mohr, B. (Author) , Oelschlägel, U. (Author) , Parmentier, S. (Author) , Röllig, C. (Author) , Kramer, M. (Author) , Platzbecker, U. (Author) , Illmer, T. (Author) , Thiede, C. (Author) , Bornhäuser, M. (Author) , Ehninger, G. (Author)
Format: Article (Journal)
Language:English
Published: 2015
In: Leukemia
Year: 2014, Volume: 29, Issue: 5, Pages: 1060-1068
ISSN:1476-5551
DOI:10.1038/leu.2014.335
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1038/leu.2014.335
Verlag, lizenzpflichtig, Volltext: https://www.nature.com/articles/leu2014335
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Author Notes:J Schetelig, M Schaich, K Schäfer-Eckart, M Hänel, WE Aulitzky, H Einsele, N Schmitz, W Rösler, M Stelljes, CD Baldus, AD Ho, A Neubauer, H Serve, J Mayer, WE Berdel, B Mohr, U Oelschlägel, S Parmentier, C Röllig, M Kramer, U Platzbecker,T Illmer, C Thiede, M Bornhäuser and G Ehninger on behalf of the Study Alliance Leukemia (SAL)
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Summary:The optimal timing of allogeneic hematopoietic stem cell transplantation (HCT) in acute myeloid leukemia (AML) is controversial. We report on 1179 patients with a median age of 48 years who were randomized upfront. In the control arm, sibling HCT was scheduled in the first complete remission for intermediate-risk or high-risk AML and matched unrelated HCT in complex karyotype AML. In the experimental arm, matched unrelated HCT in first remission was offered also to patients with an FLT3-ITD (FMS-like tyrosine kinase 3-internal tandem duplication) allelic ratio >0.8, poor day +15 marrow blast clearance and adverse karyotypes. Further, allogeneic HCT was recommended in high-risk AML to be performed in aplasia after induction chemotherapy. In the intent-to-treat (ITT) analysis, superiority of the experimental transplant strategy could not be shown with respect to overall survival (OS) or event-free survival. As-treated analyses suggest a profound effect of allogeneic HCT on OS (HR 0.73; P=0.002) and event-free survival (HR 0.67; P<0.001). In high-risk patients, OS was significantly improved after allogeneic HCT in aplasia (HR 0.64; P=0.046) and after HCT in remission (HR 0.74; P=0.03). Although superiority of one study arm could not be demonstrated in the ITT analysis, secondary analyses suggest that early allogeneic HCT is a promising strategy for patients with high-risk AML.
Item Description:Published: 01 December 2014
Gesehen am 18.06.2020
Physical Description:Online Resource
ISSN:1476-5551
DOI:10.1038/leu.2014.335

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