Autologous Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia in First Complete Remission: A Meta-Analysis of Randomized Trials

Abstract

Background: For those patients who are not candidates for allogeneic stem cell transplantation (SCT) or who do not have an HLA-matched donor, it is unclear whether consolidation therapy with autologous SCT results in a survival benefit compared with further intensive post-remission non-myeloablative chemotherapy or no further therapy. Methods: A meta-analysis evaluating autologous SCT versus further chemotherapy or no treatment for acute myeloid leukemia (AML) in first complete remission (CR1) was completed. The search used the following combined search terms in Medline, Embase, the Cochrane Controlled Trials Register, the Cochrane Library, the Web of Science and the China National Knowledge Infrastructure. Results: Overall, 13 studies of 12 randomized controlled trials were identified. Four studies were in pediatric patients and 9 were in adults. For adults, AML in CR1 compared with non-SCT, lower relapse and higher transplantation-related mortality were associated with autologous SCT, a significant disease-free survival benefit of autologous SCT was documented, and there was no difference in overall survival when studies were pooled. For pediatric AML in CR1, there were no differences in relapse, transplantation-related mortality, disease-free survival and overall survival. Significantly less survival from relapse impairment was found for autologous SCT. Conclusion: Our results support the conclusion that autologous SCT should not be considered as the first-line post-remission therapy for AML patients in CR1.

Intravenous busulfan for autologous stem cell transplantation in adult patients with acute myeloid leukemia: a survey of 952 patients on behalf of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

“…of life compared with patients who undergo ASCT. 32 Several randomized studies 24,25,[33][34][35][36] comparing allogeneic stem cell transplantation using HLA-identical siblings after a myeloablative conditioning regimen with ASCT and chemotherapy have reported better outcomes after allogeneic transplantation, but they have also consistently shown a decreased relapse incidence after ASCT compared with conventional chemotherapy. However, to date no randomized study has demonstrated the superiority of allogeneic transplantation using an alternative donor (unrelated or cord blood) over ASCT.…”

“…In adults with AML, historical series of ASCT from various institutions, 17 retrospective surveys from the European Group for Blood and Marrow Transplantation (EBMT) [18][19][20][21][22] and the Center for International Blood and Marrow Transplant Research, 23 and randomized trials 24,25 have revealed long-term leukemia-free survival rates of 45-55% in patients transplanted in first remission and 25-35% for those transplanted in second remission. 26 However, in contrast to the considerable experience using oral busulfan in high-dose regimens, no studies have reported outcomes using intravenous busulfan-based conditioning regimens for ASCT.…”

Revisiting G-CSF Support for Hematologic Recovery after Autologous Transplantation in AML Patients

“…Consequently, they are offered consolidation treatment in CR1 with either conventional chemotherapy, autologous or allogeneic transplantation [2][3][4]. Among these options, high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) can be applied to consolidate CR1 in AML patients who have favorable or intermediate risk cytogenetic and molecular abnormalities [5][6][7][8].…”

T-cell-replete haploidentical transplantation versus autologous stem cell transplantation in adult acute leukemia: a matched pair analysis

“…Regarding ASCT, retrospective studies from various centers, [22][23][24][25] the EBMT 26,27 and the Center for International Blood and Marrow Transplantation Research (CIBMTR) 28 as well as numerous randomized studies [29][30][31][32][33][34] have indicated that the long-term leukemia-free survival of AML patients autografted in CR1 is approximately 50%, whereas that for patients autografted in CR2 is approximately 30%. Results in ALL have been inferior.…”