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Author Notes:

Erica D. Warlick, MD; University of Minnesota, Division of Hematology, Oncology and Transplantation, Mayo Mail Code 480; 420 Delaware St SE, Minneapolis, Minnesota 55455; Telephone: 612-625-5467; Fax: 612-625-6919; ewarlick@umn.edu.

We would also like to acknowledge contributions to protocol development from the following individuals: Alison W. Loren; Ann E. Woolfrey; Ayman Saad; Camille Abboud; Dipnarine Maharaj; Edward A. Copelan; Franklin O. Smith; Jeffrey Szer; Jacob M. Rowe; James M. Foran; James L. Gajewski; Joseph H. Antin; Joseph Pidala; H. Kent Holland; Martin S. Tallman; Maxim Norkin; Michael R. Bishop; Mitchell S. Cairo; Muthalagu Ramanathan; Rodrigo Martino; Peter H. Wiernik; Robert K. Stuart; Stella Santarone; and William R. Drobyski.

J Koreth has compensated consultant/advisory relationships with Spectrum Pharmaceuticals and Eleven Biotherapeutics; honoraria from Optum Health; and research funding from Millennium Pharmaceuticals, Otsuka Pharmaceuticals, and Prometheus Cabs.

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Research Funding:

The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24 CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement U10 HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-12-1-0142 and N00014-13-1-0039 from the Office of Naval Research; and grants from Allos Therapeutics, Inc.; Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; Blue Cross and Blue Shield Association; Celgene Corporation; Fresenius-Biotech North America, Inc.; Gamida Cell Teva Joint Venture Ltd.; Genentech, Inc.; Gentium SpA; Genzyme Corporation; GlaxoSmithKline; HistoGenetics, Inc.; Kiadis Pharma; The Leukemia & Lymphoma Society; The Medical College of Wisconsin; Merck & Co, Inc.; Millennium: The Takeda Oncology Co.; Milliman USA, Inc.; Miltenyi Biotec, Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; Remedy Informatics; Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; Tarix Pharmaceuticals; TerumoBCT; Teva Neuroscience, Inc.; THERAKOS, Inc.; and Wellpoint, Inc.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology
  • Immunology
  • Transplantation
  • AML
  • RIC
  • Cytarabine consolidation
  • HEMATOPOIETIC-CELL TRANSPLANTATION
  • ACUTE MYELOGENOUS LEUKEMIA
  • HIGH-DOSE CYTARABINE
  • PREPARATIVE REGIMENS
  • CHEMOTHERAPY
  • IMPACT
  • ADULTS
  • BLOOD

Effect of Postremission Therapy before Reduced-Intensity Conditioning Allogeneic Transplantation for Acute Myeloid Leukemia in First Complete Remission

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Journal Title:

Biology of Blood and Marrow Transplantation

Volume:

Volume 20, Number 2

Publisher:

, Pages 202-208

Type of Work:

Article | Post-print: After Peer Review

Abstract:

The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P= 16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P= 15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P= 80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.

Copyright information:

© 2014 American Society for Blood and Marrow Transplantation.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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