Skip to main content
SpringerLink
Log in

Effects of post-remission chemotherapy before allo-HSCT for acute myeloid leukemia during first complete remission: a meta-analysis

  • Review Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is most frequently used to treat acute myeloid leukemia (AML). Whether patients should routinely receive consolidation chemotherapy before proceeding to transplant after achieving first complete remission (CR1) has been a subject of debate. We performed a systematic review and meta-analysis of studies examining the impact of post-remission chemotherapy before allo-HSCT in patients with AML in CR1. Six studies including 1659 patients were included in the meta-analysis. The pooled hazard ratio (HR) for overall survival was 0.9 (95% confidence interval [CI] 0.77–1.05, P = 0.182), and the pooled HR for leukemia-free survival was 0.87 (95% CI 0.75–1.0, P = 0.07). No survival advantage was observed for post-remission chemotherapy before reduced-intensity conditioning or myeloablative conditioning (MAC) allo-HSCT for AML in CR1. The pooled relative risk for relapse incidence (RI) was 1.02 (95% CI 0.82–1.28, P = 0.834). Post-remission chemotherapy before allo-HSCT did not significantly affect the RI in patients with AML in CR1. The analyses revealed no significant benefit of post-remission consolidation chemotherapy in patients who received allo-HSCT. We recommend proceeding to allo-HSCT as soon as CR1 is attained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Baldomero H, Gratwohl M, Gratwohl A, Tichelli A, Niederwieser D, Madrigal A, Frauendorfer K (2011) The EBMT activity survey 2009: trends over the past 5 years. Bone Marrow Transplant 46:485–501

    Article  PubMed  CAS  Google Scholar 

  2. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, Duarte RF, Dufour C, Kuball J, Farge-Bancel D, Gennery A, Kroger N, Lanza F, Nagler A, Sureda A, Mohty M (2016) Hematopoietic stem cell transplantation in Europe 2014: more than 40 000 transplants annually. Bone Marrow Transplant 51:786–792

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Mayer RJ, Davis RB, Schiffer CA, Berg DT, Powell BL, Schulman P, Omura GA, Moore JO, McIntyre OR, Frei ER (1994) Intensive postremission chemotherapy in adults with acute myeloid leukemia. Cancer and Leukemia Group B. N Engl J Med 331:896–903

    Article  PubMed  CAS  Google Scholar 

  4. Gupta V, Tallman MS, Weisdorf DJ (2011) Allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia: myths, controversies, and unknowns. Blood 117:2307–2318

    Article  PubMed  CAS  Google Scholar 

  5. Cahn JY, Labopin M, Sierra J, Blaise D, Reiffers J, Ferrant A, Bergmann L, Visani G, Cornelissen J, De Witte T, Bosi A, Frassoni F, Gorin NC (2000) No impact of high-dose cytarabine on the outcome of patients transplanted for acute myeloblastic leukaemia in first remission. Br J Haematol 110:308–314

    Article  PubMed  CAS  Google Scholar 

  6. Tallman MS, Rowlings PA, Milone G, Zhang MJ, Perez WS, Weisdorf D, Keating A, Gale RP, Geller RB, Laughlin MJ, Lazarus HM, Luger SM, McCarthy PL, Rowe JM, Saez RA, Vowels MR, Horowitz MM (2000) Effect of postremission chemotherapy before human leukocyte antigen-identical sibling transplantation for acute myelogenous leukemia in first complete remission. Blood 96:1254–1258

    PubMed  CAS  Google Scholar 

  7. Wells G, Shea B, Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  8. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16

    Article  PubMed  PubMed Central  Google Scholar 

  9. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  10. Assal A, Jakubowski AA, Maloy M, Zheng J, Devlin SM, Avecilla S, Barker JN, Castro-Malaspina H, Dahi P, Gyurkocza B, Meagher R, Perales M, Shaffer B, Tamari R, Young JW, Giralt SA, Papadopoulos EB (2016) The role of post-remission chemotherapy before T-cell depleted allogeneic stem cell transplant for acute myeloid leukemia in first complete remission. Biol Blood Marrow Transplant 22:S197–S198

    Article  Google Scholar 

  11. McCormack SE, Cao Q, Oran B, Weisdorf DJ, Warlick ED (2011) Pre-transplant consolidation chemotherapy may not improve outcomes after reduced intensity conditioning hematopoietic stem cell transplantation for acute myeloid leukemia in first complete remission. Leuk Res 35:757–761

    Article  PubMed  CAS  Google Scholar 

  12. Warlick ED, Paulson K, Brazauskas R, Zhong X, Miller AM, Camitta BM, George B, Savani BN, Ustun C, Marks DI, Waller EK, Baron F, Freytes CO, Socie G, Akpek G, Schouten HC, Lazarus HM, Horwitz EM, Koreth J, Cahn JY, Bornhauser M, Seftel M, Cairo MS, Laughlin MJ, Sabloff M, Ringdén O, Gale RP, Kamble RT, Vij R, Gergis U, Mathews V, Saber W, Chen YB, Liesveld JL, Cutler CS, Ghobadi A, Uy GL, Eapen M, Weisdorf DJ, Litzow MR (2014) Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission. Biol Blood Marrow 20:202–208

    Article  Google Scholar 

  13. Yeshurun M, Labopin M, Blaise D, Cornelissen JJ, Sengeloev H, Vindelov L, Kuball J, Chevallier P, Craddock C, Socie G, Bilger K, Schouten HC, Fegueux N, Goker H, Maertens J, Bunjes D, Arnold R, Nagler A, Mohty M (2014) Impact of postremission consolidation chemotherapy on outcome after reduced-intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia in first complete remission: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Cancer 120:855–863

    Article  PubMed  Google Scholar 

  14. Ganapule A, Phillip C, Lakshmi K, George B, Viswabandya A, Abraham A, Ahmed R, Srivastava A, Mathews V (2013) Clinical outcome of allogeneic SCT with a RIC regimen in young adults with AML in CR1: impact of prior consolidation therapy. Biol Blood Marrow Transpl 19:S246

    Article  Google Scholar 

  15. Kolb H, Schmid C, Barrett AJ, Schendel DJ (2004) Graft-versus-leukemia reactions in allogeneic chimeras. Blood 103:767

    Article  PubMed  CAS  Google Scholar 

  16. Cassileth PA, Lynch E, Hines JD, Oken MM, Mazza JJ, Bennett JM, McGlave PB, Edelstein M, Harrington DP, O’Connell MJ (1992) Varying intensity of postremission therapy in acute myeloid leukemia. Blood 79:1924–1930

    PubMed  CAS  Google Scholar 

  17. Stelljes M, Krug U, Beelen DW, Braess J, Sauerland MC, Heinecke A, Ligges S, Sauer T, Tschanter P, Thoennissen GB, Berning B, Kolb HJ, Reichle A, Holler E, Schwerdtfeger R, Arnold R, Scheid C, Müller-Tidow C, Woermann BJ, Hiddemann W, Berdel WE, Büchner T (2014) Allogeneic transplantation versus chemotherapy as postremission therapy for acute myeloid leukemia: a prospective matched pairs analysis. J Clin Oncol 32:288–296

    Article  PubMed  Google Scholar 

  18. Ustun C, Wiseman AC, Defor TE, Yohe S, Linden MA, Oran B, Burke M, Warlick E, Miller JS, Weisdorf D (2013) Achieving stringent CR is essential before reduced-intensity conditioning allogeneic hematopoietic cell transplantation in AML. Bone Marrow Transplant 48:1415–1420

    Article  PubMed  CAS  Google Scholar 

  19. Walter RB, Buckley SA, Pagel JM, Wood BL, Storer BE, Sandmaier BM, Fang M, Gyurkocza B, Delaney C, Radich JP, Estey EH, Appelbaum FR (2013) Significance of minimal residual disease before myeloablative allogeneic hematopoietic cell transplantation for AML in first and second complete remission. Blood 122:1813–1821

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Acknowledgments

We sincerely thank all patients and clinical investigators who were involved in the studies selected for this meta-analysis.

Author information

Authors and Affiliations

  1. Department of Therapeutic Centre of Anemia, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College (CAMS & PUMC), Tianjin, People’s Republic of China

    Yangmin Zhu, Qingyan Gao, Jun Du, Jing Hu, Xu Liu & Fengkui Zhang

Authors
  1. Yangmin Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qingyan Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fengkui Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fengkui Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, Y., Gao, Q., Du, J. et al. Effects of post-remission chemotherapy before allo-HSCT for acute myeloid leukemia during first complete remission: a meta-analysis. Ann Hematol 97, 1519–1526 (2018). https://doi.org/10.1007/s00277-018-3414-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-018-3414-6

Keywords

Search

Navigation