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<p>While allogeneic stem cell transplantation (allo-SCT) is the preferred consolidation for high and most intermediate-risk acute myeloid leukemia (AML) patients in first remission, the role of autologous SCT (auto-SCT) vs. chemotherapy (CT) when allo-SCT is not feasible or indicated, remains controversial. We conducted a real-world, retrospective cohort study using the PETHEMA AML registry to compare auto-SCT and CT. Multivariate Cox regression and propensity score matching (PS-matching) were used to adjust for confounding factors. A total of 1272 patients in first remission and who received 2 consolidation courses were included (615 receiving additional CT cycles and 657 undergoing auto-SCT). Overall, 78.08% of auto-SCT patients were diagnosed before 2017, compared to 38.11% in the CT cohort (<i>p</i> &lt; 0.001). In the overall cohort, auto-SCT was associated with significantly prolonged overall survival (OS) (HR: 0.73, <i>p</i> &lt; 0.001) and relapse-free survival (RFS) (HR: 0.73, <i>p</i> &lt; 0.001). This benefit was particularly evident in patients ≤65 years, those with normal karyotype, and FLT3-ITD negativity. In the PS-matched cohort, the RFS advantage persisted (HR: 0.80, <i>p</i> = 0.092), but OS differences were not statistically significant (HR: 0.91, <i>p</i> = 0.563). The role of auto-SCT in the genomic and targeted agent era should not be discarded.</p>

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Long-term benefits of autologous stem cell transplantation versus intensive chemotherapy consolidation for acute myeloid leukemia patients: A propensity score matching analysis from the PETHEMA AML registry

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月1日

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  • Ana Alfonso-Pierola,
  • David Martinez-Cuadrón,
  • Rebeca Rodríguez-Veiga,
  • Cristina Gil,
  • Pilar Martínez-Sánchez,
  • Teresa Bernal,
  • Celina Benavente,
  • Mónica A. Romero-Riquelme,
  • Josefina Serrano-Lopez,
  • Juan M. Bergua,
  • Raimundo García-Boyero,
  • Mar Tormo,
  • Pilar Herrera,
  • Claudia L. Sossa-Melo,
  • José A. Pérez-Simon,
  • Carlos Rodríguez-Medina,
  • María F. Bass-Maturana,
  • José L. López-Lorenzo,
  • Lorenzo Algarra-Algarra,
  • Belén Vidriales-Vicente,
  • Manuel Pérez-Encinas,
  • Manuel Barrios-García,
  • Susana Vives,
  • María J. Sayas-Lloris,
  • Marisa Capurro,
  • Sebastián Hidalgo,
  • Mayte Olave,
  • Diana Cuervo-Lozada,
  • Esperanza Lavilla-Rubira,
  • Felipe Casado,
  • Armando Mena-Durán,
  • Marta Valero-Nuñez,
  • Soledad Casado-Calderón,
  • Amaia Balerdi,
  • Vivianne Torres,
  • Rosa Fernández,
  • Víctor Noriega,
  • Mariana Stevenazzi,
  • Jorge Labrador,
  • Pilar León-Maldonado,
  • Beatriz de Rueda-Ciller,
  • Olga Arce-Fernández,
  • María L. Amigo,
  • José Ángel Raposo-Puglia,
  • María Solé,
  • Blanca Boluda,
  • Rosa Ayala,
  • Eva Barragán,
  • Pau Montesinos,
  • Beatriz de Rueda-Ciller

摘要

While allogeneic stem cell transplantation (allo-SCT) is the preferred consolidation for high and most intermediate-risk acute myeloid leukemia (AML) patients in first remission, the role of autologous SCT (auto-SCT) vs. chemotherapy (CT) when allo-SCT is not feasible or indicated, remains controversial. We conducted a real-world, retrospective cohort study using the PETHEMA AML registry to compare auto-SCT and CT. Multivariate Cox regression and propensity score matching (PS-matching) were used to adjust for confounding factors. A total of 1272 patients in first remission and who received 2 consolidation courses were included (615 receiving additional CT cycles and 657 undergoing auto-SCT). Overall, 78.08% of auto-SCT patients were diagnosed before 2017, compared to 38.11% in the CT cohort (p < 0.001). In the overall cohort, auto-SCT was associated with significantly prolonged overall survival (OS) (HR: 0.73, p < 0.001) and relapse-free survival (RFS) (HR: 0.73, p < 0.001). This benefit was particularly evident in patients ≤65 years, those with normal karyotype, and FLT3-ITD negativity. In the PS-matched cohort, the RFS advantage persisted (HR: 0.80, p = 0.092), but OS differences were not statistically significant (HR: 0.91, p = 0.563). The role of auto-SCT in the genomic and targeted agent era should not be discarded.