TY - JOUR
T1 - Outcomes of Autologous Hematopoietic Cell Transplantation Compared With Chemotherapy Consolidation Alone for Non–High-Risk Acute Myeloid Leukemia in First Complete Remission in a Minority-Rich Inner-City Cohort With Limited Access to Allografts
AU - Adrianzen Herrera, D.
AU - Kornblum, Noah
AU - Derman, Olga
AU - Bachier-Rodriguez, Lizamarie
AU - Sica, R. Alejandro
AU - Shastri, A.
AU - Janakiram, Murali
AU - Verma, Amit
AU - Braunschweig, Ira
AU - Mantzaris, Ioannis
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Introduction: In the United States, autologous hematopoietic cell transplantation (autoHCT) has fallen out of favor over chemotherapy consolidation for non–high-risk acute myeloid leukemia (AML) when allogeneic hematopoietic cell transplantation (alloHCT) is unfeasible, which is common in racial minorities because of donor registry under-representation and socioeconomic challenges. We compared autoHCT consolidation outcomes with chemotherapy alone in a minority-rich cohort in the Bronx. Patients and Methods: We identified adults with favorable or intermediate cytogenetic risk AML in first complete remission after induction at Montefiore Medical Center from 1999 to 2015, and analyzed 81 patients who received consolidation with ≥2 cycles of chemotherapy, of whom 28 received autoHCT. Results: The cohort predominantly consisted of ethnic/racial minorities (69%). Age, sex, race, presenting white cell count, and cytogenetic risk were similar between groups. The autoHCT group had longer relapse-free (RFS; 43 vs. 11 months; P = .003) and overall (OS) survival (not reached vs. 36 months; P = .043). Adjusted multivariable analysis showed significant benefit of autoHCT over chemotherapy alone for RFS (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37-0.75; P < .001) and OS (HR, 0.61; 95% CI, 0.40-0.95; P = .027). Conclusion: In this inner-city non–high-risk AML cohort, autoHCT provided OS and RFS benefit compared with chemotherapy alone. AutoHCT might constitute a valuable option for ethnic/racial minorities affected by significant barriers to alloHCT, whereas integration of measurable residual disease can help select patients more likely to benefit. Autologous transplantation consolidation for non–high-risk acute myeloid leukemia is less frequently used, yet not fully abandoned. We compared outcomes of consolidation strategies in a minority-rich cohort in the Bronx with limited access to allogeneic transplantation. Autologous transplantation conferred relapse-free and overall survival benefit over chemotherapy consolidation alone, the current standard in the United States, and it might constitute a valuable option for ethnic/racial minorities.
AB - Introduction: In the United States, autologous hematopoietic cell transplantation (autoHCT) has fallen out of favor over chemotherapy consolidation for non–high-risk acute myeloid leukemia (AML) when allogeneic hematopoietic cell transplantation (alloHCT) is unfeasible, which is common in racial minorities because of donor registry under-representation and socioeconomic challenges. We compared autoHCT consolidation outcomes with chemotherapy alone in a minority-rich cohort in the Bronx. Patients and Methods: We identified adults with favorable or intermediate cytogenetic risk AML in first complete remission after induction at Montefiore Medical Center from 1999 to 2015, and analyzed 81 patients who received consolidation with ≥2 cycles of chemotherapy, of whom 28 received autoHCT. Results: The cohort predominantly consisted of ethnic/racial minorities (69%). Age, sex, race, presenting white cell count, and cytogenetic risk were similar between groups. The autoHCT group had longer relapse-free (RFS; 43 vs. 11 months; P = .003) and overall (OS) survival (not reached vs. 36 months; P = .043). Adjusted multivariable analysis showed significant benefit of autoHCT over chemotherapy alone for RFS (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.37-0.75; P < .001) and OS (HR, 0.61; 95% CI, 0.40-0.95; P = .027). Conclusion: In this inner-city non–high-risk AML cohort, autoHCT provided OS and RFS benefit compared with chemotherapy alone. AutoHCT might constitute a valuable option for ethnic/racial minorities affected by significant barriers to alloHCT, whereas integration of measurable residual disease can help select patients more likely to benefit. Autologous transplantation consolidation for non–high-risk acute myeloid leukemia is less frequently used, yet not fully abandoned. We compared outcomes of consolidation strategies in a minority-rich cohort in the Bronx with limited access to allogeneic transplantation. Autologous transplantation conferred relapse-free and overall survival benefit over chemotherapy consolidation alone, the current standard in the United States, and it might constitute a valuable option for ethnic/racial minorities.
KW - Autologous transplant
KW - Consolidation therapy
KW - Cytogenetic risk
KW - Ethnic minorities
KW - Overall survival
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U2 - 10.1016/j.clml.2019.05.002
DO - 10.1016/j.clml.2019.05.002
M3 - Article
C2 - 31227357
AN - SCOPUS:85067277123
SN - 2152-2650
VL - 19
SP - 516
EP - 521
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 8
ER -