Autologous versus allogeneic marrow transplantation for patients with acute myeloid leukemia in 1st remission

Problem: In this trial the effectiveness and toxicity of autologous marrow transplant as a therapy of acute myeloid leukemia in 1st complete remission was evaluated by comparing it with allogeneic marrow transplantation. Methods: Twenty-eight patients with AML in Ist CR underwent ABMT. A control group consists of 40 patients treated with BMT. There is no difference between the two group concerning the sex, FAB classification, WBC at diagnosis, and cytogenetics. Patients in ABMT were older (median 34 years vs median 27 years for BMT group p = 0.06). Interval from CR to transplant is significantly longer for ABMT group (median 6 months for ABMT versus median 3 months for BMT group, p = 0.03). Median follow up is 52 months for ABMT and 108 months for BMT group. Results: For conditioning Bu/Cy (predominantly for ABMT group) or TBI/Cy (predominantly for BMT group) were used. A five-year probability of leukemia-free survival for ABMT group is 55% and for BMT is 68% (p = n.s.). A significantly higher probability of relapse was found in ABMT group (38% for ABMT vs 12% in BMT p = 0.02). In ABMT group the main cause of death was relapse. In BMT group relapse, GVHD with or without infections were the principal causes of death. Conclusion: The results confirmed that autologous marrow transplant is effective postremission therapy for patients with AML younger than 50 years of age. Relapse rate is a major problem.