title: Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission.
abstract: BACKGROUND
  In young adults with acute myeloid leukemia, intensive chemotherapy during the initial remission improves the long-term outcome, but the role of bone marrow transplantation is uncertain. We compared high-dose cytarabine with autologous or allogeneic marrow transplantation during the first remission of acute myeloid leukemia.
  
  
  METHODS
  Previously untreated adolescents and adults 16 to 55 years of age who had acute myeloid leukemia received standard induction chemotherapy. After complete remission had been achieved, idarubicin (two days) and cytarabine (five days) were administered. Patients with histocompatible siblings were offered allogeneic marrow transplantation, whereas the remaining patients were randomly assigned to receive a single course of high-dose cytarabine or transplantation of autologous marrow treated with perfosfamide (4-hydroperoxycyclophosphamide). Oral busulfan and intravenous cyclophosphamide were used as preparative regimens for both allogeneic and autologous marrow transplantation. The end points were survival from the time of complete remission and disease-free survival.
  
  
  RESULTS
  In an intention-to-treat analysis, we found no significant differences in disease-free survival among patients receiving high-dose chemotherapy, those undergoing autologous bone marrow transplantation, and those undergoing allogeneic marrow transplantation. The median follow-up was four years. Survival after complete remission was somewhat better after chemotherapy than after autologous marrow transplantation (P=0.05). There was a marginal advantage in terms of overall survival with chemotherapy as compared with allogeneic marrow transplantation (P=0.04).
  
  
  CONCLUSIONS
  A postinduction course of high-dose cytarabine can provide equivalent disease-free survival and somewhat better overall survival than autologous marrow transplantation in adults with acute myeloid leukemia.
authors.affiliation: University of Miami Sylvester Comprehensive Cancer Center, FL 33136, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Cassileth
authors.forename: D P
authors.initials: DP
authors.lastname: Harrington
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: J M
authors.initials: JM
authors.lastname: Rowe
authors.forename: E
authors.initials: E
authors.lastname: Paietta
authors.forename: C
authors.initials: C
authors.lastname: Willman
authors.forename: D D
authors.initials: DD
authors.lastname: Hurd
authors.forename: J M
authors.initials: JM
authors.lastname: Bennett
authors.forename: K G
authors.initials: KG
authors.lastname: Blume
authors.forename: D R
authors.initials: DR
authors.lastname: Head
authors.forename: P H
authors.initials: PH
authors.lastname: Wiernik
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003561:Cytarabine / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine