Donated Stem Cell Transplants Better than Self-transplants for Most Patients with AML
Adapted from the NCI Cancer Bulletin.
Evidence from a meta-analysis of prospective clinical trials supports the use of donated (or allograft) stem cell transplants (SCT), also referred to as allogeneic SCT, to treat individuals with acute myeloid leukemia (AML). The findings appeared in the June 10, 2009, issue of JAMA (see the journal abstract).
AML patients are usually classified as good-, intermediate-, or poor-risk, depending on genetic factors linked to the disease. Those in the good-risk group have the best chance of recovery and the lowest risk of relapse. The National Comprehensive Cancer Network states that those in the good-risk group should receive SCT from their own body after their initial chemotherapy, or a second round of chemotherapy if SCT is not possible; those in the poor-risk group should have an allograft SCT after chemotherapy; and those who have intermediate-risk disease can be treated either way, because it is not clear if one is better than the other.
Now, an international team of researchers led by John Koreth, M.B.B.S., D.Phil., at the Dana-Farber/Harvard Cancer Center has reviewed the literature comparing allograft and non-allograft SCT (also referred to as autologous SCT) to determine what the evidence supports for patients in each risk group based on the rates of relapse-free survival and overall survival. The researchers reviewed 24 prospective clinical trials in the United States, Europe, and Japan that included a total of 6,007 adult patients.
Patients who were in the good-risk groups showed no significant difference in relapse-free or overall survival if they received a SCT from their own body or from a donor. Those in the intermediate-risk and poor-risk groups, however, showed a clear benefit when receiving allograft SCT compared with SCT from their own bodies.
Overall, the researchers stated, the benefits of allograft SCT were markedly clearer for those in the intermediate- and poor-risk groups. But they noted that "there remains a need to further individualize the allogeneic SCT decision, based on factors like patient age, comorbidity, and the presence of additional molecular lesions."