Comparing treatment regimens in patients with relapsed or refractory acute myeloid leukemia

This study aimed to compare myeloablative transplant and a sequential approach treatment in patients with relapsed or refractory acute myeloid leukemia. This study concluded that both treatments had similar outcomes for these patients. 

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option for patients with relapsed or refractory acute myeloid leukemia (AML). It involves taking stem cells from a donor and transplanting them into the patient. The stem cells help to replenish cells that have been damaged or destroyed in AML.

Myeloablative transplant (MT) involves myeloablative chemotherapy which is followed by HSCT. Myeloablative chemotherapy is a high-dose chemotherapy. The sequential approach treatment (SAT) involves HSCT, cytoreductive chemotherapy, reduced intensity conditioning regimen and prophylactic donor lymphocyte infusions. Cytoreductive chemotherapy aims to reduce the number of cancer cells. Reduced intensity conditioning regime uses less chemotherapy than myeloablative chemotherapy. Prophylactic donor lymphocyte infusions (PDLI) prevent relapse following HSCT.

It was not known which treatment would be more beneficial to relapsed/refractory AML patients.

This study involved 99 patients aged 18-50 years who received HSCT for AML. 52% of these patients had refractory AML and 48% had relapsed AML. 58 patients received SAT and 41 patients received the MT. 6 patients received PDLI. Patients were followed for an average of 48 months.

The two-year overall survival rate (time from treatment until death from any cause) was 39% in the MT group compared to 33% in the SAT group. The two-year cumulative incidence of relapse (CIR) was 57% in the MT and 50% in the SAT group. Non-relapse mortality (death not due to relapsed disease) was 15% in the MT group and 17% in the SAT group. The SAT group experienced fewer serious to severe graft versus host disease (GVHD) cases. GVHD is a side effect of HSCT, when the transplanted cells attack healthy tissue.  

Overall survival, CIR and non-relapse mortality remained similar between the two groups. 

This study concluded that both treatment options had similar overall survival, CIR and non-relapse mortality for relapsed/refractory AML patients. 

Consult your physician about treatment options for relapsed/refractory AML.