Donor Stem-Cell Transplant Best For Acute Myeloid Leukemia

People in all risk groups, but especially those with poor and intermediate risk of survival, benefit most, researchers say

By Steven Reinberg
HealthDay Reporter

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TUESDAY, June 9 (HealthDay News) -- For most patients with acute myeloid leukemia (AML) who come out of remission, donor stem cells appear to offer the best shot at survival, a new analysis shows.

AML is the most common form of acute leukemia, striking about 12,000 adults a year in the United States. Treatment usually involves chemotherapy to achieve a first remission, but the best subsequent therapy to prolong disease-free survival has been unclear, although the researchers say the results of this latest review could lead to a new standard of care.

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"First complete remission does not mean you are cured. It doesn't mean that you have eradicated every last cancer cell; in fact, we know you haven't," said review author John Koreth of the Dana Farber Cancer Institute in Boston. "If we stop therapy, then almost invariably the disease will relapse, and you die from a relapse of the leukemia."

The next step is to achieve a cure and, for that, several treatment options exist. One is more chemotherapy; another is an autologous cell transplant, which uses the patient's own bone marrow cells. The third option is to use compatible donor stem cells in what is called an allogeneic transplant, Koreth said.

"The question has been which of these treatments is the best," he said. The report appears in the June 10 issue of the Journal of the American Medical Association.

Currently, treatment decisions are often based on risk of relapse, a determination made through chromosome analysis, called cytogenetic analysis. Depending on the results, patients are put into good-, intermediate- and poor-risk groups for the likelihood of survival at three and five years, Koreth said.

The traditional consensus has been to use chemotherapy or autologous transplants with patients in good risk. "For patients with poor-risk acute myeloid leukemia, the consensus has been they should all go to donor transplantation. For people in the biggest group, intermediate risk, there has really been no consensus," he said.

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