Until recently, allogeneic marrow transplants were the recommended consolidation treatment for all patients with a matched sibling donor regardless of the results of baseline cytogenetic testing. However, marrow transplants are associated with increased treatment-related mortality and significant adverse events such as graft versus host disease and decreased quality of life compared with chemotherapy.

A previous study had shown that patients with favorable cytogenetic findings had a good prognosis regardless of choice of consolidation treatment (namely, marrow transplant versus chemotherapy). Since then, some centers have reserved marrow transplant only for patients with nonfavorable cytogenetic findings. The current study was designed to rigorously evaluate such treatment decision-making criteria.

In the current study, researchers compared strategies to optimize treatment for adults who were in first remission and had an identified matched sibling donor (number of patients not given). Probability data from 5 previous studies were used to complete the analysis of the decision tree. Patients were categorized according to risk based on their cytogenetic profile. The ‘favorable’ group had low-risk chromosomal abnormalities. The ‘nonfavorable’ group had patients with high-risk and intermediate-risk chromosomal abnormalities.

The authors devised a decision tree for three treatment strategies: marrow transplant for all, chemotherapy for all, and, in the test treatment arm, chemotherapy for patients in the favorable cytogenetics group and matched sibling donor transplant for patients in the nonfavorable cytogenetics group. The primary endpoint was quality-adjusted life year scores that express the length and quality of remaining life for patients.

The researchers expected the test treatment arm to produce a better outcome in quality-adjusted life years than either the transplant for all or chemotherapy for all arms. The test arm based on cytogenetic risk stratification was associated with a 20.10 score compared with 19.63 and 18.38 for the marrow transplantation for all and chemotherapy all strategies, respectively.

The authors conclude, "this decision analysis model demonstrated that the 'Test' arm is expected to be superior to 'marrow transplant for All' and ‘chemotherapy for all’ by 0.47 and 1.72 quality-adjusted life years respectively" and that these differences are likely to be "clinically meaningful" for patients with acute myeloid leukemia.

The authors suggest that chemotherapy consolidation is a reasonable option for patients with favorable cytogenetics, even if a matched sibling donor is available.