January 3, 2003
Researchers find chemotherapy is an effective alternative to bone marrow transplant in acute myeloid leukemia patients with good prognosis
TORONTO - Researchers at The Hospital for Sick Children (SickKids), Mount Sinai Hospital, Princess Margaret Hospital (PMH), and Sunnybrook & Women's College Health Science Centre and the University of Toronto have found that chemotherapy is an effective alternative treatment to bone marrow transplant for adult patients with acute myeloid leukemia (AML) with good prognosis. The research will be reported in the January 15 issue of the scientific journal Cancer.
The study has found that using cytogenetic testing to direct the use of bone marrow transplant or chemotherapy treatments is more effective than using these treatment options without consideration of cytogenetic risk factors. The research determined that using chemotherapy to treat low risk AML patients and bone marrow transplant for AML patients with intermediate and high-risks was associated with a better outcome than exclusively using bone marrow transplant or chemotherapy for all AML patients.
"Adults with AML face difficult treatment decisions. Through this work we have helped define more precisely the best treatment options available to patients depending on the cytogenetics of their leukemia," said Dr. Lillian Sung, lead author of the study, and a hematology/oncology research fellow at The Hospital for Sick Children.
Currently, some centres recommend bone marrow transplant for all AML patients with a matched sibling donor. However, bone marrow transplant is associated with transplant related mortality, infections, graft versus host disease and late complications such as infertility and second cancers.
This study focused on comparing treatment strategies for adults with AML with a matched sibling donor in order to identify the optimal form of treatment. Using a formal research process called decision analysis, the researchers used probability data from five other studies. Patients were then grouped into low risk and intermediate/high risk categories based on the cytogenetics of the leukemia.
Researchers then created a decision tree using a comparison of three treatment strategies (bone marrow transplant alone, chemotherapy alone, and a test strategy that based treatment on a patient's level of risk according to the cytogenetics of their leukemia and the use of bone marrow transplant only for intermediate/high risk patients.) The group concluded that treatment informed by cytogenetics was a more effective treatment strategy and in particular, patients with low risk AML should opt for chemotherapy treatment versus bone marrow transplant.
Collaborators on this research were: Dr. Rena Buckstein, hematologist, Toronto-Sunnybrook Regional Cancer Centre/Sunnybrook and Women's College Health Science Centre, Dr. John J. Doyle, head of Bone Marrow Transplant, SickKids, Dr. Michael Crump, hematologist, Princess Margaret Hospital, Dr. Allan S. Detsky, head of Internal Medicine, Mount Sinai Hospital.
For more information, please contact:
Fiona Taylor, Public Affairs
Sunnybrook and Women's College Health Science Centre
(416) 480-4040
fiona.taylor@swchsc.on.ca
or
For more information, please contact:
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