A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission

Saiko Kurosawa, Takuhiro Yamaguchi, Shuichi Miyawaki, Naoyuki Uchida, Heiwa Kanamori, Kensuke Usuki, Takuya Yamashita, Masato Watanabe, Kazuaki Yakushiji, Shingo Yano, Yuichiro Nawa, Jun Taguchi, Jin Takeuchi, Junji Tomiyama, Yuko Nakamura, Ikuo Miura, Yoshinobu Kanda, Yoichi Takaue, Takahiro Fukuda

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)

Abstract

Various prospective trials have been performed to assess the roles of allogeneic hematopoietic cell transplantation (allo-HCT) and chemotherapy in patients with acute myeloid leukemia (AML) in first complete remission (CR1). However, the results have not always been consistent, and there has been a limited evaluation of quality of life (QOL) in these postremission strategies. We performed a Markov decision analysis that enabled us to compare survival outcomes with a QOL evaluation using a database of 2029 adult AML patients who achieved CR1. The Markov decision model compared 2 strategies: allo-HCT or chemotherapy in CR1. Patients who had intermediate- or unfavorable-risk AML had a longer life expectancy when they received allo-HCT in CR1 than patients treated with chemotherapy alone. Likewise, patients who had a suitable related donor who received allo-HCT in CR1 had a longer life expectancy. The life expectancy was shortened to a greater degree by adjustment for QOL in the allo-HCT group. Nevertheless, QOLadjusted life expectancies in most of the subgroups remained longer in the allo-HCT group than in the chemotherapy group. Our results showed that older patients with a related donor and younger patients with unfavorable cytogenetics benefited the most from allo-HCT in CR1.

Original languageEnglish
Pages (from-to)2113-2120
Number of pages8
JournalBlood
Volume117
Issue number7
DOIs
Publication statusPublished - 2011 Feb 17

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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