Résumé
Allogeneic hematopoietic stem cell transplant (SCT) remains the best curative treatment in adult acute myeloid leukemia (AML). Intensive induction chemotherapy allows elderly patients to achieve complete remission rates (CR) of around 60–70%. To date, there is no consensus concerning the consolidation treatment of AML in elderly patients in first CR, before allogeneic SCT.
This is a retrospective study including AML patients aged ≥ 60 years, in first CR and receiving allogeneic SCT. Our aim was to evaluate relapse-free survival (RFS) rates.
One hundred thirty patients with AML in first CR, were included in this study, 52% (n= 68) received intensive consolidation chemotherapy, and 48% (n=62) received a non-intensive consolidation chemotherapy. Median follow up was 52.9 months. RFS at 2 years was nearly similar between the 2 groups: 51% in the intensive group versus 50% in the non-intensive one (P=0.546). 2-year overall survival was almost similar. Adverse cytogenetics was the only significant prognostic factor, with 2-year RFS at 34% in adverse cytogenetics vs 56% for the favorable/intermediate (P=0.010) and 2-year OS at 33% and 62% respectively for adverse cytogenetic and favorable/intermediate (P=0.011).
Intensive consolidation chemotherapy does not seem to be associated with better survival in elderly AML receiving allogeneic SCT. Progress is still needed to define the best consolidation chemotherapy and increasing the feasibility of allogeneic SCT in elderly and comorbid patients and to prevent relapses.