Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India
Purpose: There are limited data from developing countries on the role and cost-effectiveness of allogeneic stem cell transplantation (allo-SCT) for patients with acute myeloid leukemia (AML). Patients and Methods: We undertook a retrospective descriptive study of all patients with AML who underwent...
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doaj-028ebafe4cfe4c75a20796534884f5be2020-11-25T03:40:39ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062017-12-013677378110.1200/JGO.2016.00665013Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in IndiaAbhijeet GanapuleSandeep NemaniAnu KorulaKavitha M. LakshmiAby AbrahamAlok SrivastavaPoonkuzhali BalasubramanianBiju GeorgeVikram MathewsPurpose: There are limited data from developing countries on the role and cost-effectiveness of allogeneic stem cell transplantation (allo-SCT) for patients with acute myeloid leukemia (AML). Patients and Methods: We undertook a retrospective descriptive study of all patients with AML who underwent allo-SCT from 1994 to 2013 at our center to evaluate the clinical outcomes and cost-effectiveness of this therapeutic modality. Results: Two hundred fifty-four consecutive patients, median age 34 years, who underwent allo-SCT at our center were included in this study. There were 161 males (63.4%). The 5-year overall survival (OS) and event-free survival for the entire cohort was 40.1 ± 3.5% and 38.7 ± 3.4%, respectively. The 5-year OS for patients in first (CR1), second, and third complete remission and with disease/refractory AML was 53.1 ± 5.2%, 48.2 ± 8.3%, 31.2 ± 17.8%, and 16.0 ± 4.4%, respectively (P < .001). From 2007, reduced intensity conditioning (RIC) with fludarabine and melphalan (Flu/Mel) was used in a majority of patients in CR1 (n = 67). Clinical outcomes were compared with historical conventional myeloablative conditioning regimens (n = 38). Use of Flu/Mel was associated with lower treatment-related mortality at 1 year, higher incidence of chronic graft-versus-host-disease, and comparable relapse rates. The 5-year OS and event-free survival for Flu/Mel and myeloablative conditioning group was 67.2 ± 6.6% versus 38.1 ± 8.1% (P = .003) and 63.8 ± 6.4% versus 32.3 ± 7.9% (P = .002), respectively. Preliminary cost analysis suggests that in our medical cost payment system, RIC allo-SCT in CR1 was likely the most cost-effective strategy in the management of AML. Conclusion: In a resource-constrained environment, Flu/Mel RIC allo-SCT for AML CR1 is likely the most efficacious and cost-effective approach in a subset of newly diagnosed young adult patients.http://ascopubs.org/doi/10.1200/JGO.2016.006650 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Abhijeet Ganapule Sandeep Nemani Anu Korula Kavitha M. Lakshmi Aby Abraham Alok Srivastava Poonkuzhali Balasubramanian Biju George Vikram Mathews |
spellingShingle |
Abhijeet Ganapule Sandeep Nemani Anu Korula Kavitha M. Lakshmi Aby Abraham Alok Srivastava Poonkuzhali Balasubramanian Biju George Vikram Mathews Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India Journal of Global Oncology |
author_facet |
Abhijeet Ganapule Sandeep Nemani Anu Korula Kavitha M. Lakshmi Aby Abraham Alok Srivastava Poonkuzhali Balasubramanian Biju George Vikram Mathews |
author_sort |
Abhijeet Ganapule |
title |
Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India |
title_short |
Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India |
title_full |
Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India |
title_fullStr |
Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India |
title_full_unstemmed |
Allogeneic Stem Cell Transplant for Acute Myeloid Leukemia: Evolution of an Effective Strategy in India |
title_sort |
allogeneic stem cell transplant for acute myeloid leukemia: evolution of an effective strategy in india |
publisher |
American Society of Clinical Oncology |
series |
Journal of Global Oncology |
issn |
2378-9506 |
publishDate |
2017-12-01 |
description |
Purpose: There are limited data from developing countries on the role and cost-effectiveness of allogeneic stem cell transplantation (allo-SCT) for patients with acute myeloid leukemia (AML). Patients and Methods: We undertook a retrospective descriptive study of all patients with AML who underwent allo-SCT from 1994 to 2013 at our center to evaluate the clinical outcomes and cost-effectiveness of this therapeutic modality. Results: Two hundred fifty-four consecutive patients, median age 34 years, who underwent allo-SCT at our center were included in this study. There were 161 males (63.4%). The 5-year overall survival (OS) and event-free survival for the entire cohort was 40.1 ± 3.5% and 38.7 ± 3.4%, respectively. The 5-year OS for patients in first (CR1), second, and third complete remission and with disease/refractory AML was 53.1 ± 5.2%, 48.2 ± 8.3%, 31.2 ± 17.8%, and 16.0 ± 4.4%, respectively (P < .001). From 2007, reduced intensity conditioning (RIC) with fludarabine and melphalan (Flu/Mel) was used in a majority of patients in CR1 (n = 67). Clinical outcomes were compared with historical conventional myeloablative conditioning regimens (n = 38). Use of Flu/Mel was associated with lower treatment-related mortality at 1 year, higher incidence of chronic graft-versus-host-disease, and comparable relapse rates. The 5-year OS and event-free survival for Flu/Mel and myeloablative conditioning group was 67.2 ± 6.6% versus 38.1 ± 8.1% (P = .003) and 63.8 ± 6.4% versus 32.3 ± 7.9% (P = .002), respectively. Preliminary cost analysis suggests that in our medical cost payment system, RIC allo-SCT in CR1 was likely the most cost-effective strategy in the management of AML. Conclusion: In a resource-constrained environment, Flu/Mel RIC allo-SCT for AML CR1 is likely the most efficacious and cost-effective approach in a subset of newly diagnosed young adult patients. |
url |
http://ascopubs.org/doi/10.1200/JGO.2016.006650 |
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