Abstract

To examine the outcome of allogeneic stem cell transplantation (HSCT) in first complete remission (CR1) compared to chemotherapy alone in a population-based setting, we identified a cohort of acute myeloid leukemia (AML) patients aged 15-70 years diagnosed between 2000-2014 in Denmark. Using the Danish National Acute Leukemia Registry, we compared relapse risk, relapse-free survival (RFS), and overall survival between patients with non-favorable cytogenetic features receiving post-remission 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 alloHSCT as a time-dependent covariate, and stratified results by age, (<60, =60 years) and cytogenetic risk group. Overall, 1031 patients achieved a CR1. Of these, 196 patients (19%) underwent HSCT. HSCT was associated with decreased relapse-rates (24% versus 49%), despite similar median-time to relapse (287 days versus 265 days). In all subgroups, the risk of relapse was lower, and both relapse-free and overall survival was superior among patients receiving HSCT (overall survival, adjusted mortality ratios (MRs): all patients: 0.54 (CI=0.42-0.71), patients<60 years, 0.58 (CI=0.42-0.81), patients=60 years, 0.42 (CI=0.26-0.69), intermediate risk cytogenetics, 0.63 (CI=0.43-0.87), and adverse risk cytogenetics, 0.40 (CI=0.24-0.67)). In conclusion, in this population-based nation-wide cohort study, HSCT was associated with improved survival both in younger and older patients with intermediate and adverse cytogenetic risk.

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