DÄ internationalArchive6/2009Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: Statement Was Not Sufficiently Supported


Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: Statement Was Not Sufficiently Supported

Dtsch Arztebl Int 2009; 106(6): 98. DOI: 10.3238/arztebl.2009.0098a

Herrmann-Frank, A; Koch, K; Lange, S; Sawicki, P T

LNSLNS Zander et al. conclude in their article that in patients with acute myeloid leukemia who are in second remission the result of transplantation from unrelated donors are "equivalent" to those from sibling donors. This statement is not supported by the literature cited by Zander et al. The publication cited in support (1) does not mention any comparison of related and unrelated donors. The article is an evaluation of a registry of patients with promyelocytic leukemia who had either received autologous transplants or a transplant from an HLA identical sibling donor. It does thus not contradict our conclusion (2) in the IQWiG (Institute for Quality and Efficiency in Health Care-Home) report. The most suitable instruments for comparing therapeutic alternatives are prospective, controlled studies that ensure identical structures. "Genetically randomized" studies have shown that studies that are fairly close approximations of this design are possible even in stem cell transplantation. One such study was conducted, for example, which compared transplantation with dose reduced conditioning versus chemotherapy (3). The study showed a clear advantage of dose-reduced conditioning in leukemia-free survival. In addition to many other studies of a similar design, it confirmed our approach (2) that it is entirely possible to evaluate stem cell transplantation in a methodologically valid manner and with relevance to health care delivery.
DOI: 10.3238/arztebl.2009.0098a

PD Dr. rer. nat. Annegret Herrmann-Frank, Dr. rer. medic. Klaus Koch,
PD Dr. med. Stefan Lange, Prof. Dr. med. Peter T. Sawicki
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)
Dillenburger Str. 27, 51105 Köln, Germany

IQWiG has compiled a report on the subject.