title: A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission.
abstract: Intensive, myelosuppressive therapy is necessary to maximize outcomes for patients with acute myeloid leukemia (AML). A comparison was made of 3 aggressive postremission approaches for children and adolescents with AML in a randomized trial, CCG-2891. A total of 652 children and adolescents with AML who achieved remission on 2 induction regimens using identical drugs and doses (standard and intensive timing) were eligible for allocation to allogeneic bone marrow transplantation (BMT) based on matched related donor status (n = 181) or randomization to autologous BMT (n = 177) or to aggressive high-dose cytarabine-based chemotherapy (n = 179). Only 115 patients (18%) refused to participate in the postremission phase of this study. Overall compliance with the 3 allocated regimens was 90%. At 8 years actuarial, 54% +/- 4% (95% confidence interval) of all remission patients remain alive. Survival by assigned regimen ("intent to treat") is as follows: allogeneic BMT, 60% +/- 9%; autologous BMT, 48% +/- 8%; and chemotherapy, 53% +/- 8%. Survival in the allogeneic BMT group is significantly superior to autologous BMT (P =.002) and chemotherapy (P =.05); differences between chemotherapy and autologous BMT are not significant (P =.21). No potential confounding factors affected results. Patients receiving intensive-timing induction therapy had superior long-term survival irrespective of postremission regimen received (allogeneic BMT, 70% +/- 9%; autologous BMT, 54% +/- 9%; chemotherapy, 57% +/- 10%). Allogeneic BMT remains the treatment of choice for children and adolescents with AML in remission, when a matched related donor is available. For all others, there is no advantage to autologous BMT; hence, aggressive nonablative chemotherapy should be used.
authors.affiliation: South Carolina Cancer Center, Columbia, SC, USA.
authors.forename: W G
authors.initials: WG
authors.lastname: Woods
authors.forename: S
authors.initials: S
authors.lastname: Neudorf
authors.forename: S
authors.initials: S
authors.lastname: Gold
authors.forename: J
authors.initials: J
authors.lastname: Sanders
authors.forename: J D
authors.initials: JD
authors.lastname: Buckley
authors.forename: D R
authors.initials: DR
authors.lastname: Barnard
authors.forename: K
authors.initials: K
authors.lastname: Dusenbery
authors.forename: J
authors.initials: J
authors.lastname: DeSwarte
authors.forename: D C
authors.initials: DC
authors.lastname: Arthur
authors.forename: B J
authors.initials: BJ
authors.lastname: Lange
authors.forename: N L
authors.initials: NL
authors.lastname: Kobrinsky
mesh_terms: D000206:Actuarial Analysis; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity; D016026:Bone Marrow Transplantation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000592:standards; D014184:Transplantation, Homologous / Q000592:standards; D016896:Treatment Outcome