A comparison of bone marrow transplantation with maintenance chemotherapy for patients with acute nonlymphoblastic leukemia in first complete remission

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Abstract
Twenty patients treated with maintenance chemotherapy [cytarabine, thioguanine] for acute nonlymphoblastic leukemia after achieving complete remission were compared with 13 patients who underwent bone marrow transplantation from an HLA-identical sibling. The median age was 27 yr for both maintenance chemotherapy patients (range 17-42 yr) and for patients undergoing bone marrow transplantation (range 16-42 yr). The 1-yr survival for maintenance chemotherapy was 80 vs. 54% with bone marrow transplantation (P = NS [not significant]). Complete remission durability was 70% at 1 yr of maintenance chemotherapy (34% projected for 5 yr) compared with 0 relapses in the 1st year with bone marrow transplantation (P = 0.01). Patients on maintenance chemotherapy were hospitalized for an average of 22 days (range 0-171 days) during the 1st 12 mo. of treatment. Patients undergoing bone marrow transplantation were hospitalized for an average of 82 days (range 41-113 days) in the same time period. Severe hematologic toxicity was seen in 13/13 bone marrow transplantation patients and 6/20 maintenance chemotherapy patients. Chronic graft-vs.-host disease occurred in 3/7 surviving bone marrow transplantation patients. Maintenance chemotherapy had an average 1st yr cost of $3,076.00 for patients who did not relapse and $48,827.00 for patients that relapsed. The 1st yr costs for bone marrow transplantation averaged $84,102.00. Thus, maintenance chemotherapy was associated with a better early survival, less toxicity and lower cost than bone marrow transplantation in the 1st yr after initiating therapy. However, fewer relapses with bone marrow transplantation suggest that it will yield a higher long-term survival rate.