Allogeneic bone marrow transplantation versus intensification chemotherapy for acute myelogenous leukaemia in first remission: a prospective controlled trial

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Abstract
Summary: In 1982 we began a prospective controlled trial to assess the effectiveness of allogeneic bone marrow transplantation and intensive post‐remission chemotherapy for patients with acute myelogenous leukaemia in first complete remission. Fourteen patients, 3–45 years of age, who had an HLA‐identical sibling donor, received bone marrow transplantation. Twenty‐five patients who either lacked an HLA‐identical sibling or were over 45 years of age received intensive consolidation chemotherapy including high‐dose cytosine arabinoside with or without adriamycin.The actuarial rate of continued complete remission (CCR) at 3 years was significantly higher in the transplantation group than in the chemotherapy group: 70% (95% confidence interval 35–91%) compared with 10% (95% confidence interval 2–30%); P = 0·01. However, the actuarial rate of CCR was not significantly different between the transplantation group and patients under 45 years in the chemotherapy group: 70% (95% confidence interval 35‐91%) compared with 17% (95% confidence interval 4–45%), 0·1>P>0·05. The actuarial probability of leukaemia relapse was significantly lower in the transplantation group than in the chemotherapy group: 10% (95% confidence interval 4–21%) compared with 88% (95% confidence interval 70–96%), 0·005 >P>0·001. There was no significant difference between both groups if we compare only the patients who died of non‐leukaemic causes: 22%, (95% confidence interval 9–42%) versus 25% (95% confidence interval 7–59%), P = NS.In summary, this study shows that allogeneic bone marrow transplantation is a better anti‐leukaemic treatment than is intensive consolidation chemotherapy in patients with AML in first complete remission.