BOSTON--A stem cell transplant (SCT) from a compatible donor early in the course of disease is the best approach for the majority of young and middle-aged adult patients with acute myeloid leukemia (AML), according to a new analysis of two dozen clinical studies.
The findings of the study, published in the June 10 issue of the Journal of the American Medical Association by researchers at Dana-Farber Cancer Institute and other institutions, provide new guidelines for treatment of the disease. For all AML patients other than the minority with "good-risk" disease, SCT from a compatible donor significantly improves survival, making it the preferred approach, the authors state.
The customary treatment for AML involves an initial "induction" phase that uses a combination of chemotherapy agents to put the disease into a first remission. The second stage of treatment, called "consolidation," is undertaken with the goal to cure the disease. Consolidation options include additional rounds of chemotherapy; autologous transplantation (which uses a patient's own blood stem cells); or allogeneic SCT (in which compatible donor cells are transplanted).
Traditionally, the treatment offered to patients has largely been based on a chromosome analysis of their AML cells. For AML with "good-risk" chromosome changes, additional chemotherapy or an autologous transplant is usually recommended. For AML with "poor-risk" changes, allogeneic SCT is usually recommended. For AML with "intermediate-risk" changes (the largest group), there has been no consensus on the best treatment.
In the new study, researchers confirmed that, consistent with current practice, patients with poor-risk AML benefited significantly from an allogeneic transplant performed in first remission, while those with good-risk disease did not benefit from the procedure. For patients with intermediate-risk disease, who account for nearly half of all adult AML patients, allogen
|Contact: Bill Schaller|
Dana-Farber Cancer Institute