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

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.

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Journal
Leukemia
Published
2025-09-01
DOI
https://doi.org/10.1038/s41375-025-02744-x
Primary Topic
Acute Myeloid Leukemia Research
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article
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article

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

Pilar Martínez‐Sánchez, Pau Montesinos, Mariana Stevenazzi, Rebeca Rodríguez‐Veiga et al.
Leukemia
Acute Myeloid Leukemia Research
article

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

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

Abstract

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.

LeukemiaVol. 39(11)
Hospital Universitario Insular de Gran Canaria (ES), Universidad Católica de Temuco (CL), Hospital Clínico San Carlos (ES), Hospital Universitari i Politècnic La Fe (ES), Hospital General Universitario Morales Meseguer (ES), Hospital de Basurto (ES), Hospital Base (CL), Hospital Clínico Universitario de Valencia (ES), Complejo Hospitalario Universitario de Santiago (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Hospital del Salvador (CL), Complejo Hospitalario de Salamanca (ES), Hospital Carlos Van Buren (CL), Hospital Regional Universitario de Málaga (ES), Hospital San Pedro de Alcántara (ES), Hospital Universitario Miguel Servet (ES), Hospital Universitario de Burgos (ES), Hospital Arnau de Vilanova (ES), Hospital Regional de Concepción (CL), Hospital Universitario Reina Sofía (ES), Hospital General Universitari de Castelló (ES), Hospital Universitario Doctor Peset (ES), Hospital General Universitario De Valencia (ES), Hospital Juan Ramón Jiménez (ES), Hospital Universitario Fundación Jiménez Díaz (ES), Hospital Universitario Central de Asturias (ES), Clinica Universidad de Navarra (ES), Hospital Clínico Universitario Lozano Blesa (ES), Hospital de Cruces (ES), Hospital Universitario HM Sanchinarro (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Centro de Implantología Cirugía Oral y Maxilofacial (ES), Fundación Arturo López Pérez (CL), Complexo Hospitalario Universitario A Coruña (ES), Hospital Universitario Puerta del Mar (ES), Hospital Universitario Lucus Augusti (ES), Hospital General Universitario de Albacete (ES), Foscal Hospital (CO), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital de Clínicas (UY), Hospital Universitario Ramón y Cajal (ES), Hospital Universitario Infantil San José (CO)
Instituto de Salud Carlos III
Openalex Percentile: Top 70%
Acute Myeloid Leukemia Research
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