Efficacy of autologous versus allogeneic peripheral blood hematopoietic stem cell transplantation in non-high-risk acute myeloid leukemia patients in first complete remission

Abstract

] Objective To compare the efficacy of autologous and allogeneic peripheral blood hematopoietic stem cell transplantation (PB-HCT) for non-high-risk acute myeloid leukemia (AML) patients having achieved first complete remission (CR1). Methods A total of 73 patients with CR1 stage AML (non-high risk) who underwent PB-HCT in our department from January 2012 to June 2019 were enrolled in this study, and they were 49 patients receiving allogeneic PB-HCT and 24 getting autologous PB-HCT. The time of hematopoietic reconstruction, required transfusion volume, the number times of early infections, 1-year cumulative relapse incidence (RI) and non-relapse mortality (NRM), 1-year overall survival (OS) and leukemia-free survival (LFS) were compared between the 2 groups. Results There were no significant differences in hematopoietic reconstruction time, required transfusion volume and the number times of early infections between the 2 groups. As for the autologous PB-HCT group and allogeneic PB-HCT group, 1-year RI was 25.4% and 6.2% (P < 0.01); 1-year NRM was 0.0% and 8.3% (P=0.15); 1-year OS was 95.8% and 89.5% (P=0.80); and 1-year LFS was 74.6% and 85.6% (P=0.07), respectively. Among the low-risk patients, there were no obvious differences in RI, NRM, LFS, and OS between the 2 groups. For the intermediate-risk patients, 1-year NRM and OS were not significantly different, 1-year RI was 31.6% and 8.8% (P < 0.01), and 1-year LFS was 68.4% and 85.3% (P=0.02), respectively. Furthermore, the intermediate-risk patients who received MSD (HLA-matched sibling donor) PB-HCT had higher LFS than the autologous group (90.5% vs 68.4%, P < 0.01), while the LFS of the patients undergoing haploid-identical PB-HCT was not statistically different from autologous PB-HCT. Conclusion Autologous and allogeneic PB-HCT can result in a similar effect in the low-risk AML patients at the CR1 stage. Moreover, allogeneic PB-HCT is more effective for intermediate-risk patients, but only for the patients undergoing MSD PB-HCT. If there is a lack of HLA-matched sibling donor, autologous PB-HCT is an effective alternative.

Keywords

• acute myeloid leukemia
• first complete remission
• autologous transplantation
• allografts transplantation