Allogenic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia with or without Consolidation Chemotherapy

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a highly effective post- remission treatment for patients with AML in first complete remission. The role of post-remission consolidation chemotherapy with allo-HSCT remains controversial. This study was performed to evaluate the post-remission chemotherapy efficacy before Allo-HSCT. The study included 66 acute leukemia (AML) patients who received induction regimen containing cytarabine given for 7 days and idarubicin (7+3) given for 3 days from April 2008 to July 2013. Thirty -two of patients received only induction therapy (group A) and 34 patients (group B) received induction and post-remission chemotherapy containing 5 days cytarabine and 2 days idarubicin (5+2). The conditioning regimen for transplantation was busulfan and cyclophosphsmide. Graft-versus-host disease (GvHD) prophylaxis regimen consisted of methotraxate and cyclosporin. The median follow-up was 20 (21 in group A and 19.5 in group B) months. The median time to neutrophil recovery was 12 (range: 9 to 50) and 14 (range: 10 to 27) days in groups A and B, respectively (p=0.07). The median time to platelet recovery was 15 (9 to 47) days in group A and 16 (9 to 54) days in group B (p=0.54). Acute GvHD occurred in 18 patients (6 in grade I, 8 in grade II, and 4 in grade III) in group A and 20 patients (5 grade I, 9 grade II, 6 grade III, and 1 in grade IV) in group B (56.2% vs. 58.8%; p=0.833). Eight patients experienced relapses (7 in group A and 1 in group B). Twenty-one patients (9 in group A and 12 in group B) expired. The most common causes of death were GvHD (10), relapse (5) and infection (4). Two-year leukemia-free survival (DFS) was 65.9% (SE: 9.5%) and 66.4% (SE: 8.3%) in groups A and B, respectively (p=0.547). The study indicated that there were no differences in allo-HSCT outcomes between patients with or without consolidation chemotherapy. More cases and longer time are required to confirm the preliminary data.