Outcomes of Autologous Hematopoietic Cell Transplantation Compared to Chemotherapy Consolidation Alone for Non-High Risk Acute Myeloid Leukemia in First Complete Remission in a Minority-Rich Inner-City Cohort with Limited Access to Allografts

Abstract Introduction In the United States, autologous hematopoietic cell transplantation (autoHCT) has fallen out of favor over chemotherapy consolidation for non-high-risk acute myeloid leukemia (AML) when allogeneic HCT (alloHCT) is unfeasible, which is common in racial minorities due to donor registry underrepresentation and socioeconomic challenges. We compared autoHCT consolidation outcomes to chemotherapy alone in a minority-rich cohort in the Bronx. Materials and Methods We identified adults with favorable or intermediate cytogenetic risk AML in first complete remission after induction at Montefiore Medical Center from 1999 to 2015, and analyzed 81 cases consolidated with ≥2 cycles of chemotherapy, of which 28 received autoHCT. Results The cohort predominantly consisted of ethnic/racial minorities (69%). Age, sex, race, presenting white cell count and cytogenetic risk were similar between groups. The autoHCT group had longer relapse-free (RFS) (43 vs. 11 months, p=0.003) and overall survival (OS) (not reached vs. 36 months, p=0.043). Adjusted multivariable analysis showed significant benefit of autoHCT over chemotherapy alone for RFS (HR 0.53, 95% confidence interval [CI] 0.37 – 0.75, p Conclusion In this inner-city non-high risk AML cohort, autoHCT provided OS and RFS benefit compared to chemotherapy alone. AutoHCT may constitute a valuable option for ethnic/racial minorities affected by significant barriers to alloHCT, while integration of measurable residual disease can help select patients more likely to benefit.