Abstract

Despite a lack of evidence that postremission consolidation chemotherapy improves outcome of allogeneic transplantation in patients with acute myeloid leukemia (AML) in first remission, high dose cytarabine and other regimens are commonly administered to these patients. We studied a consecutive cohort of 73 adult patients with AML at high risk of relapse by published criteria who underwent allogeneic transplantation in first remision to determine whether specific patient and treatment characteristics identified subgroups of patients who might benefit from consolidation therapy prior to allogeneic transplantation. Pretransplant cytogenetics were available for 56 patients. Transplantation occurred between 1988 and 2008. The primary analysis grouped patients according to cytogenetic risk (poor versus intermediate) and consolidation chemotherapy (yes versus no).

 Consolidation Chemotherapy No Consolidation Chemotherapy 
None of the measured outcomes (relapse mortality (RM), non-relapse mortality (NRM), overall survival (OS)) differed significantly between groups. 
Poor Risk Cytogenetics 13 
Intermediate Risk   
 18 16 
Cytogenetics   
 Consolidation Chemotherapy No Consolidation Chemotherapy 
None of the measured outcomes (relapse mortality (RM), non-relapse mortality (NRM), overall survival (OS)) differed significantly between groups. 
Poor Risk Cytogenetics 13 
Intermediate Risk   
 18 16 
Cytogenetics   
P Values for Consolidation Versus No Consolidation by Cytogenetic Risk 
 Poor Risk Cytogenetics Intermediate Risk Cytogenetics 
When cytogenetic risk was not stratified the results between consolidation and no consolidation were also not significant. 
RM 0.95 0.74 
NRM 0.73 0.19 
OS 0.77 0.21 
P Values for Consolidation Versus No Consolidation by Cytogenetic Risk 
 Poor Risk Cytogenetics Intermediate Risk Cytogenetics 
When cytogenetic risk was not stratified the results between consolidation and no consolidation were also not significant. 
RM 0.95 0.74 
NRM 0.73 0.19 
OS 0.77 0.21 
P Values for Consolidation Versus No Consolidation 
RM 0.70 
NRM 0.12 
OS 0.14 
P Values for Consolidation Versus No Consolidation 
RM 0.70 
NRM 0.12 
OS 0.14 

Neither this study nor others provide evidence that consolidation chemotherapy is beneficial to all patients with AML in first remission who undergo allogeneic transplant or to cytogenetic subgroups. Delays in referral to a transplant center, in tissue typing or physician preference to administer consolidation chemotherapy are not justified and expose patients to the inconvenience, risk, and cost of unnecessary treatment. Clinicians should avoid consolidation chemotherapy and expedite allogeneic transplantion in patients with AML in first remission in whom transplantation is the preferred treatment.

Disclosures: No relevant conflicts of interest to declare.

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