Quality-adjusted survival after treatment for acute myeloid leukemia in childhood: A Q-TWiST analysis of the Pediatric Oncology Group study 8821

purpose: Ta describe quality-of-life considerations in postremission therap ies for children with acute myelogenous leukemia. Patients and Methods: A quality-adjusted survival analysis, using the quali ty-adjusted time without symptoms or toxicity (Q-TWiST) method, was applied to Pediatric Oncology Group Trial 8821,which compared randomized assignmen t with intensive consolidation chemotherapy (CC) or autologous bone marrow trans plantation (ABMT), Nonrandomized assignment to allogeneic bone marrow transplantation (allo BMT) on the basis of availability of a matched relat ed donor wets also evaluated. A 25 patient cohort provided data for modelin g chronic graft-versus-host disease. The TWiST analysis war performed based on the intent-to-treat principle. Results: As previously reported, the 3 year event-free survival was not sig nificantly different between the randomized arms (CC v ABMT), At a median f ollow-up of 5 years (of the censoring distribution), the CC group had less time in toxicity (TOX) and more time without symptoms ar toxicity (TWiST), relapse-free time, and alive time than patients assigned to ABMT (none of t hese were statistically significant). Compared with the CC group alla BMT p atients spent more time in TOX (P <.001), more time in TWiST (P =.06), and had more relapse-free time (P =.03) and time alive (P = .07), Allo BMT was superior to ABMT with greater time in TWiST (P =.03), relapse-free time (P =.01), and time alive P = .002). Conclusion: The Q-TWiST analysis is a powerful decision aid in choosing amo ng alternative therapies. prospective information on patient preferences wi ll facilitate future trials evaluating treatment outcomes. Refinements in t he Q-TWiST method could be included to further enhance the power of this pa tient care decisionmaking tool.