General AML

Autologous Stem Cell Transplantation consolidation in first remission is well-tolerated and effective in elderly AML patients: a Swiss study

The outcomes of elderly Acute Myeloid Leukemia (AML) patients are poor and the effectiveness and benefit of Autologous Stem Cell Transplantation (ASCT) consolidation in these patients are poorly understood.

Alexander D. Heini  and colleagues from the University of Bern, Switzerland, and colleagues published a retrospective analysis on the benefits and tolerance of ASCT consolidation in AML patients ≥65 years in First Complete Remission (CR1). The data were published in Leukemia Research  in February 2017.

In this study, the authors studied the survival outcomes of AML patients ≥65 years (n = 40) undergoing busulfan/cyclophosphamide conditioning before ASCT. The patients had been treated between 2007 and 2015 at the University Hospital Bern, Switzerland.

The key results are:

  • Median Progression Free Survival (PFS) in AML patients with ASCT consolidation (n =16) compared to patients without ASCT consolidation (n =24); 16.3 vs 5.1 months, P = 0.0166
  • The median Overall Survival (OS) in AML patients without ASCT consolidation (n = 24) was 8.2 months compared to AML patients with ASCT consolidation (n = 16) which has not been reached; P = 0.0255
  • Median PFS in ≥65 years (n = 16) and <65 years (n = 49) AML patients with ASCT consolidation in CR1 were 16.3 and 30.8 months respectively, P = 0.9462
  • Median OS in ≥65 years (n = 16) and <65 years (n = 49) AML patients were not reached and 56.4 months respectively, P = 0.7867

In summary, ASCT consolidation in elderly AML patients in CR1 is feasible, tolerable and provides longer survival benefits which are similar to younger AML patients. This is the largest study to date to investigate the effect of ASCT consolidation in elderly patients in comparison with elderly patients without ASCT consolidation. However, the authors highlighted that their retrospective study might have some bias in terms of patient selection.

The authors concluded by suggesting that ASCT should be considered as a tolerable and effective option for consolidation in elderly AML patients above the age of 65 in  and should be investigated in future prospective studies.

Abstract

The outcome of AML patients ≥65 years remains disappointing. Current post-induction strategies for elderly AML patients fit for intensive treatment involve additional cycles of chemotherapy or allogeneic transplantation. Consolidation with autologous transplantation (ASCT) is poorly studied in these patients. In this single-center retrospective analysis, we determined survival rates of AML patients ≥65 years undergoing busulfan/cyclophosphamide conditioning before ASCT in first remission between 2007 and 2015. We found elderly AML patients with ASCT to have longer progression-free survival (PFS; 16.3 vs. 5.1 months, P = 0.0166) and overall survival (OS; n.r. vs. 8.2 months; P = 0.0255) than elderly AML patients without ASCT consolidation. In addition, elderly AML patients undergoing ASCT had comparable PFS (P = 0.9462) and OS (P = 0.7867) as AML patients below 65 years receiving ASCT consolidation in CR1. Our data suggest that ASCT is an option in elderly fit AML patients who appear to benefit from autologous consolidation similarly to younger AML patients.

References
  1. Heini A. D. et al. Consolidation with autologous stem cell transplantation in first remission is safe and effective in AML patients above 65 years. Leukemia Research. 2017 Feb 1; 53(2017): 28-34. DOI: 10.1016/j.leukres.2016.12.001. Epub 2016 Dec 8.