Among patients with acute myeloid leukemia (AML), the type of anthracycline received, and whether some patients undergoing stem cell transplantation have a human leukocyte antigen (HLA)-identical donor, may not affect long-term outcomes, according to results published in the American Journal of Hematology.

As many as 80% of patients with AML, aged 15 to 60 years, reach a complete remission with cytarabine and an anthracycline, including daunorubicin, mitoxantrone, or idarubicin. Previous study results, reported using a median follow-up of 5.6 years, suggested that type of anthracycline did not affect outcomes among those with an HLA-identical donor, though those without a donor appeared to have improved disease-free survival with mitoxantrone and idarubicin.

There is, however, a paucity of long-term outcome data in this setting, and the best post-remission treatment, particularly for younger patients, has not yet been established. In the present paper, researchers report long-term follow-up data from patients included in the EORTC/GIMEMA AML-10 trial (ClinicalTrials.gov Identifier: NCT00002549), with the aim of determining whether variety of anthracycline affects long-term outcomes, and, further, whether having an HLA-identical donor is linked with improved outcomes among those reaching a complete remission with complete (CR) or incomplete (CRi) recovery.

Between 1993 and 1999, 2157 patients were randomly assigned to receive 1 of the 3 anthracyclines for de novo AML (2064 patients), secondary AML (46 patients), or treatment-related AML (47 patients). Patient characteristics were well-balanced and median follow-up was 11 years.


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The 5-, 10-, and 15-year overall survival (OS) rates were 33.2%, 30.1%, and 28%, respectively, and type of anthracycline did not affect OS outcomes (P =.38). However, among patients aged 46 to 60 years, mitoxantrone and idarubicin appeared to confer a higher OS (P =.029).

In patients who were younger than 46 years with a CR/CRi, those with an HLA-identical donor (330 patients) appeared to have improved 10-year OS vs those without a donor (509 patients; hazard ratio, 0.79; P = .02). Older patients (aged 46 years and older) with a CR/CRi had similar long-term outcomes regardless of whether donors were HLA-identical.

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“In summary, to the best of our knowledge this study reports the first evidence-based data with regard to long-term impact of anthracycline-type and donor availability on outcomes in younger AML patients,” the authors wrote. “[I]n the group of younger patients without favourable cytogenetic features who reached CR/CRi, the long-term outcome was improved when an HLA-identical sibling donor was available.”

Disclosures: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the reference for a complete list of authors’ disclosures.

Reference

Baron F, Efficace F, Cannella L, et al. Impact of the type of anthracycline and of stem cell transplantation in younger patients with acute myeloid leukaemia: long-term follow up of a phase III study [published online March 31, 2020]. Am J Hematol. doi: 10.1002/ajh.25795