Allogeneic stem cell transplantation in second rather than first complete remission in selected patients with good-risk acute myeloid leukemia

Through two consecutive trials, a policy that considered allogeneic stem cell transplantation ( SCT) from a sibling donor in second rather than first complete remission ( CR) in selected younger patients with acute myeloid leukemia ( AML) with t( 8; 21)/ inv( 16) ( core binding factor ( CBF) group) or a normal karyotype ( NN group) was followed by Acute Leukemia French Association ( ALFA) centers. The outcome of 92 of these patients in first relapse ( 32 CBF, 60 NN) was reviewed with the aim of validating this strategy. The presence of an FLT3 internal tandem duplication ( ITD) was retrospectively assessed in 50 patients. A total of 61 patients ( 66%) reached a second CR. Donor availability was an independent prognostic factor for survival in the whole patient population as well as in the CBF subset, but not in NN patients, further supporting this strategy for CBF- AMLs. In NN patients, FLT3- ITD was the main bad- prognosis factor for second CR achievement and survival, leading to consider SCT earlier, at least in FLT3- ITD patients with a donor.