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

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Abstract

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.

Original languageEnglish (US)
JournalClinical Lymphoma, Myeloma and Leukemia
DOIs
StatePublished - Jan 1 2019

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Consolidation Chemotherapy
Cell Transplantation
Acute Myeloid Leukemia
Allografts
Drug Therapy
Autologous Transplantation
Cytogenetics
Confidence Intervals
Remission Induction
Recurrence
Survival
Homologous Transplantation
Registries
Cell Count
Tissue Donors

Keywords

  • Autologous transplant
  • Consolidation therapy
  • Cytogenetic risk
  • Ethnic minorities
  • Overall survival

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{974a4c95164e46828f7341aaf19659a7,
title = "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",
abstract = "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.",
keywords = "Autologous transplant, Consolidation therapy, Cytogenetic risk, Ethnic minorities, Overall survival",
author = "{Adrianzen Herrera}, Diego and Noah Kornblum and Olga Derman and Lizamarie Bachier-Rodriguez and Sica, {R. Alejandro} and Aditi Shastri and Murali Janakiram and Amit Verma and Ira Braunschweig and Ioannis Mantzaris",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clml.2019.05.002",
language = "English (US)",
journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2669",
publisher = "Cancer Media Group",

}

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, Diego

AU - Kornblum, Noah

AU - Derman, Olga

AU - Bachier-Rodriguez, Lizamarie

AU - Sica, R. Alejandro

AU - Shastri, Aditi

AU - Janakiram, Murali

AU - Verma, Amit

AU - Braunschweig, Ira

AU - Mantzaris, Ioannis

PY - 2019/1/1

Y1 - 2019/1/1

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

JO - Clinical Lymphoma, Myeloma and Leukemia

JF - Clinical Lymphoma, Myeloma and Leukemia

SN - 2152-2669

ER -