Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study

Lene Sofie Granfeldt Østgård; Jennifer L. Lund; Jan Maxwell Nørgaard; Mette Nørgaard; Bruno C. Medeiros; Bendt Nielsen; Ove Juul Nielsen; Ulrik Malthe Overgaard; Maria Kallenbach; Claus Werenberg Marcher; Anders Hammerich Riis; Henrik Sengeløv

doi:10.1016/j.bbmt.2017.10.019

Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study

Lene Sofie Granfeldt Østgård, Jennifer L. Lund, Jan Maxwell Nørgaard, Mette Nørgaard, Bruno C. Medeiros, Bendt Nielsen, Ove Juul Nielsen, Ulrik Malthe Overgaard, Maria Kallenbach, Claus Werenberg Marcher, Anders Hammerich Riis, Henrik Sengeløv^*

^*Corresponding author for this work

Department of Clinical Medicine

15 Citations (Scopus)

Abstract

To examine the outcomes of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared with chemotherapy alone in a population-based setting, we identified a cohort of patients with acute myeloid leukemia (AML) aged 15 to 70 years diagnosed between 2000 and 2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival (OS) between patients with unfavorable cytogenetic features receiving postremission therapy with conventional chemotherapy only versus those undergoing HSCT in CR1. To minimize immortal time bias, we performed Cox proportional hazards regression, included date of allogeneic HSCT as a time-dependent covariate, and stratified the results by age (<60 or ≥60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with a lower relapse rate (24% versus 49%) despite a similar median time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower and both RFS and OS were superior in recipients of HSCT (OS, adjusted mortality ratios: all patients, .54 [95% confidence interval (CI), .42-.71]; patients age <60 years, .58 [95% CI, .42-.81]; patients age ≥60 years, .42 [95% CI, .26-.69]; patients with intermediate-risk cytogenetics, .63 [95% CI, .43-.87]; patients with adverse-risk cytogenetics, .40 [95% CI, .24-.67]). In conclusion, in this population-based nationwide cohort study, HSCT was associated with improved survival in both younger and older patients and in patients with both intermediate and adverse cytogenetic risk.

Original language	English
Journal	Biology of Blood and Marrow Transplantation
Volume	24
Issue number	2
Pages (from-to)	314-323
ISSN	1083-8791
DOIs	https://doi.org/10.1016/j.bbmt.2017.10.019
Publication status	Published - Feb 2018

Keywords

Acute myeloid leukemia
Allogeneic stem cell transplantation
Chemotherapy
Comparative effectiveness
Population-based
Survival

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http://www.bbmt.org/article/S1083879117307784/pdfLicence: CC BY-NC-ND

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Østgård, L. S. G., Lund, J. L., Nørgaard, J. M., Nørgaard, M., Medeiros, B. C., Nielsen, B., Nielsen, O. J., Overgaard, U. M., Kallenbach, M., Marcher, C. W., Riis, A. H., & Sengeløv, H. (2018). Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study. Biology of Blood and Marrow Transplantation, 24(2), 314-323. https://doi.org/10.1016/j.bbmt.2017.10.019

Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia : A National Population-Based Cohort Study. / Østgård, Lene Sofie Granfeldt; Lund, Jennifer L.; Nørgaard, Jan Maxwell et al.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 2, 02.2018, p. 314-323.

Research output: Contribution to journal › Journal article › Research › peer-review

Østgård, LSG, Lund, JL, Nørgaard, JM, Nørgaard, M, Medeiros, BC, Nielsen, B, Nielsen, OJ, Overgaard, UM, Kallenbach, M, Marcher, CW, Riis, AH & Sengeløv, H 2018, 'Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study', Biology of Blood and Marrow Transplantation, vol. 24, no. 2, pp. 314-323. https://doi.org/10.1016/j.bbmt.2017.10.019

@article{2c4751f4435f4f1ca92e860ec4a6a925,

title = "Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study",

abstract = "To examine the outcomes of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared with chemotherapy alone in a population-based setting, we identified a cohort of patients with acute myeloid leukemia (AML) aged 15 to 70 years diagnosed between 2000 and 2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival (OS) between patients with unfavorable cytogenetic features receiving postremission therapy with conventional chemotherapy only versus those undergoing HSCT in CR1. To minimize immortal time bias, we performed Cox proportional hazards regression, included date of allogeneic HSCT as a time-dependent covariate, and stratified the results by age (<60 or ≥60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with a lower relapse rate (24% versus 49%) despite a similar median time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower and both RFS and OS were superior in recipients of HSCT (OS, adjusted mortality ratios: all patients, .54 [95% confidence interval (CI), .42-.71]; patients age <60 years, .58 [95% CI, .42-.81]; patients age ≥60 years, .42 [95% CI, .26-.69]; patients with intermediate-risk cytogenetics, .63 [95% CI, .43-.87]; patients with adverse-risk cytogenetics, .40 [95% CI, .24-.67]). In conclusion, in this population-based nationwide cohort study, HSCT was associated with improved survival in both younger and older patients and in patients with both intermediate and adverse cytogenetic risk.",

keywords = "Acute myeloid leukemia, Allogeneic stem cell transplantation, Chemotherapy, Comparative effectiveness, Population-based, Survival",

author = "{\O}stg{\aa}rd, {Lene Sofie Granfeldt} and Lund, {Jennifer L.} and N{\o}rgaard, {Jan Maxwell} and Mette N{\o}rgaard and Medeiros, {Bruno C.} and Bendt Nielsen and Nielsen, {Ove Juul} and Overgaard, {Ulrik Malthe} and Maria Kallenbach and Marcher, {Claus Werenberg} and Riis, {Anders Hammerich} and Henrik Sengel{\o}v",

year = "2018",

month = feb,

doi = "10.1016/j.bbmt.2017.10.019",

language = "English",

volume = "24",

pages = "314--323",

journal = "Biology of Blood and Marrow Transplantation",

issn = "1083-8791",

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TY - JOUR

T1 - Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia

T2 - A National Population-Based Cohort Study

AU - Østgård, Lene Sofie Granfeldt

AU - Lund, Jennifer L.

AU - Nørgaard, Jan Maxwell

AU - Nørgaard, Mette

AU - Medeiros, Bruno C.

AU - Nielsen, Bendt

AU - Nielsen, Ove Juul

AU - Overgaard, Ulrik Malthe

AU - Kallenbach, Maria

AU - Marcher, Claus Werenberg

AU - Riis, Anders Hammerich

AU - Sengeløv, Henrik

PY - 2018/2

Y1 - 2018/2

N2 - To examine the outcomes of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared with chemotherapy alone in a population-based setting, we identified a cohort of patients with acute myeloid leukemia (AML) aged 15 to 70 years diagnosed between 2000 and 2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival (OS) between patients with unfavorable cytogenetic features receiving postremission therapy with conventional chemotherapy only versus those undergoing HSCT in CR1. To minimize immortal time bias, we performed Cox proportional hazards regression, included date of allogeneic HSCT as a time-dependent covariate, and stratified the results by age (<60 or ≥60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with a lower relapse rate (24% versus 49%) despite a similar median time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower and both RFS and OS were superior in recipients of HSCT (OS, adjusted mortality ratios: all patients, .54 [95% confidence interval (CI), .42-.71]; patients age <60 years, .58 [95% CI, .42-.81]; patients age ≥60 years, .42 [95% CI, .26-.69]; patients with intermediate-risk cytogenetics, .63 [95% CI, .43-.87]; patients with adverse-risk cytogenetics, .40 [95% CI, .24-.67]). In conclusion, in this population-based nationwide cohort study, HSCT was associated with improved survival in both younger and older patients and in patients with both intermediate and adverse cytogenetic risk.

AB - To examine the outcomes of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared with chemotherapy alone in a population-based setting, we identified a cohort of patients with acute myeloid leukemia (AML) aged 15 to 70 years diagnosed between 2000 and 2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival (OS) between patients with unfavorable cytogenetic features receiving postremission therapy with conventional chemotherapy only versus those undergoing HSCT in CR1. To minimize immortal time bias, we performed Cox proportional hazards regression, included date of allogeneic HSCT as a time-dependent covariate, and stratified the results by age (<60 or ≥60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with a lower relapse rate (24% versus 49%) despite a similar median time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower and both RFS and OS were superior in recipients of HSCT (OS, adjusted mortality ratios: all patients, .54 [95% confidence interval (CI), .42-.71]; patients age <60 years, .58 [95% CI, .42-.81]; patients age ≥60 years, .42 [95% CI, .26-.69]; patients with intermediate-risk cytogenetics, .63 [95% CI, .43-.87]; patients with adverse-risk cytogenetics, .40 [95% CI, .24-.67]). In conclusion, in this population-based nationwide cohort study, HSCT was associated with improved survival in both younger and older patients and in patients with both intermediate and adverse cytogenetic risk.

KW - Acute myeloid leukemia

KW - Allogeneic stem cell transplantation

KW - Chemotherapy

KW - Comparative effectiveness

KW - Population-based

KW - Survival

U2 - 10.1016/j.bbmt.2017.10.019

DO - 10.1016/j.bbmt.2017.10.019

M3 - Journal article

C2 - 29051022

AN - SCOPUS:85035218394

SN - 1083-8791

VL - 24

SP - 314

EP - 323

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

IS - 2

ER -

Impact of Allogeneic Stem Cell Transplantation in First Complete Remission in Acute Myeloid Leukemia: A National Population-Based Cohort Study

Abstract

Keywords

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