Originally published as JCO Early Release 10.1200/JCO.2005.02.5940 on September 26 2005

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Early Allogeneic Stem-Cell Transplantation for Young Adults With Acute Myeloblastic Leukemia in First Complete Remission: An Intent-to-Treat Long-Term Analysis of the BGMT Experience

From the Département d'Hématologie, Hôpital Caremeau, Centre Hospitalier Universitaire (CHU), Nîmes; Département d'Hématologie, Hôpital Haut-Levêque, CHU, Bordeaux; Unité de Cytogénétique and Département d'Hématologie, Hôpital Purpan, CHU, Toulouse; Département d'Hématologie and Unité de Biostatistiques, Institut Paoli Calmettes, Marseille; Département d'Hématologie, Hôpital Michalon, CHU, Grenoble; and Département d'Hématologie, Hôpital Lapeyronie, CHU, Montpellier, France.

Address reprint requests to Didier Blaise, Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli Calmettes, 232 Blvd Sainte Marguerite, 13273 Marseille Cedex 9, France; e-mail: uttc{at}marseille.fnclcc.fr

PURPOSE: We analyzed the impact of allogeneic stem-cell transplantation (alloSCT) as an early consolidation for young patients with acute myeloblastic leukemia in first complete remission (CR1) through four successive protocols.

PATIENTS AND METHODS: Of the 472 patients who achieved CR1, 182 (38%) had an HLA-identical sibling (donor group), and alloSCT was performed in 171 patients (94%). Of the 290 patients without donor (no-donor group), 62% received an autologous SCT.

RESULTS: In an intent-to-treat analysis based on donor availability, the overall 10-year survival probability was 51% v 43% (P = .11) for the donor and no-donor groups, respectively. A Cox analysis determined that four factors had independent prognostic significance for survival (initial WBC count, French-American-British subtypes, cytogenetic risk, and number of induction courses). This permitted constitution of a simple index that reclassified 21% of the patients compared with usual cytogenetic classification and identified three subpopulations with different outcome and different impact of alloSCT.

CONCLUSION: AlloSCT was associated with a survival advantage for an intermediate-risk group. In other groups, numbers are limited for definitive conclusion. However, early performed alloSCT does not seem to be the optimal treatment of high-risk patients or offer any advantage over intensive chemotherapy in low-risk patients.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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