Akademik Veri Yönetim Sistemi
7th INTERNATIONAL CONGRESS ON LEUKEMIA, LYMPHOMA, MYELOMA, İstanbul, Türkiye, 3 - 04 Mayıs 2019, ss.38-39
OP-012 Abstract Referance: 51
COMPARISON OF CONSOLIDATION STRATEGIES IN ACUTE
MYELOID LEUKEMIA: STANDARD CHEMOTHERAPY
VS AUTOLOGOUS HEMATOPOIETIC STEM CELL
TRANSPLANTATION
Asena Dikyar, Zeynep Arzu Yeğin, Lale Aydın Kaynar, Ferda Can, Zübeyde Nur Özkurt, Münci Yağcı
Gazi University School of Medicine, Department of Hematology
Background: Treatment of acute myeloid leukemia (AML) is based on
remission induction therapy and several consolidation approaches including
standard consolidation regimens such as high dose/intermediate dose
Ara-C (HIDAC/IDAC) and allogeneic hematopoietic stem cell transplantation
(HSCT) based on risk assessment models, particularly cytogenetics.
Autologous HSCT is considered as a feasible option for patients without
adverse cytogenetics and HLA-compatible donors. The aim of this study is
to compare the efficacy of HIDAC/IDAC regimens and autologous HSCT as
consolidation modalities in terms of relapse and overall survival (OS) in AML
patients.
Methods: A total of 101 patients [median age: 47(19-79) years; M/F: 51/50]
who were diagnosed as AML between in 2002 and 2019 were reviewed in
this retrospective study.
Results: After standard 7+3 remission induction therapy, 70 patients (69.3%)
continued with consolidation chemotherapy including 3 to 4 courses of
HIDAC/IDAC, while autologous HSCT was performed in 31 patients (30.7%)
after the first consolidation course. Patient characteristics are summarized
in Table 1. All patients were in complete remission before HSCT. G-CSF was used for median 8(1-16) days during stem cell mobilization. Median infused
CD34+ cell count was 4.47(2.2-5.86)x106/kg. Neutrophil and platelet engraftments
were achieved on day 12(9-27) and 13(10-202), respectively. Grade
1(1-3) mucositis was observed during peri-engraftment period. A total of
16 patients (51.6%) had neutropenic fever and 1patient (3.2%) had sinusoidal
obstruction syndrome. In chemotherapy group, 22 patients (31.4%)
experienced hematological relapse at median 330(60-2190) days after the
first remission, 4 of these patients (18.2%) underwent allogeneic HSCT for
salvage treatment. A total of 14 patients (45.2%) relapsed at median 225(60-
395) days after autologous HSCT and 12 patients (85.7%) underwent allogeneic
HSCT in this group. At a median follow-up of 915(30-4470) days, OS was
found to be better in autologous HSCT group compared to chemotherapy
group without statistical significance [79.2% vs 38.8%, p=0.054] (Figure 1).
Leukemia risk status at diagnosis was considered as the only prognostic
parameter for OS in Cox regression analysis (p=0.002).
Conclusions: In this study, the superiority of consolidative autologous HSCT
was demonstrated in AML patients compared to standard chemotherapy
arm, without statistical significance. This favourable issue, despite high and
early relapse rates after autologous HSCT, may be explained by the additive
positive impact of high percentage of salvage allogeneic HSCT in this group
of patients. Furthermore, patients in the chemotherapy arm were relatively
older and had more comorbidities compared to HSCT group. As leukemia
risk status at diagnosis was indicated to be the only statistically significant
factor for OS, the importance of patient-based treatment decisions in newly-
diagnosed AML patients should be underlined. Small sample size may
be another explanation for statistical inconvenience. Further studies are
required in order to standardize consolidation strategies in AML patients.
Keywords: Acute Myeloid Leukemia; Autologous Stem Cell Transplantation;
Consolidation Therapy; Prognosis