To determine which treatment is best for which patient, Koreth's team analyzed data from 24 clinical trials. They looked at the relapse-free survival and the benefit of allogeneic stem-cell transplantation vs. nonallogeneic stem-cell transplantation, plus chemotherapy for patients who had good, intermediate or poor survival risk.
The researchers found that patients with poor- and intermediate-risk AML who received allogeneic stem cell transplants -- the donor stem cells -- in first clinical remission were more likely to survive and less likely to suffer a relapse over the long term than patients given alternative therapies.
"For all comers, there is a statistically meaningful survival benefit to getting a donor transplant," Koreth said.
People in the poor-risk group had a survival advantage, which is consistent with current practice, he noted.
Without a donor transplant, the survival range for those in the poor-risk group is 15 percent to 20 percent at five years. With a donor transplant, the chance of disease-free survival at five years is about 33 percent.
For patients in the intermediate-risk group, a donor transplant was also clearly associated with improved survival -- of around 40 percent, Koreth said. This could become the new standard of care for these patients, he said.
"This is obviously not a home run yet," Koreth said. "We need better treatments, but for what we have today, this [donor cell transplantation] is a better treatment than the alternative."
Dr. Marshall A. Lichtman, professor of medicine, biochemistry and biophysics at the University of Rochester Medical Center, described the study as a very thoughtful analysis of a complex problem.
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