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

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

来源：Blood, 2011, 117(7): 2113-2120.

DOI：10.1182/blood-2010-05-285502

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, QOL-adjusted 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. (Blood. 2011;117(7):2113-2120)

• 出版日期2011-2-17