Transplant or chemotherapy in acute myelogenous leukaemia. International Bone Marrow Transplant Registry.

It is not known whether chemotherapy or bone-marrow transplantation is the more effective treatment for acute myelogenous leukaemia (AML) in first remission. Consequently, some centres recommend transplants only for patients for whom a poor response to chemotherapy is predicted. To assess how reasonable this strategy is, data from 704 recipients of HLA-identical sibling transplants for AML in first remission were analysed. 5-year leukaemia-free survival (LFS) was 48% (95% confidence interval 43-53%); leukaemia relapse rate was 20% (16-24%). Improved LFS was associated with younger age and lower white blood cell count at diagnosis. These prognostic variables are similar to those reported to affect outcome after chemotherapy. These findings suggest that a strategy of treatment assignment based on risk factor analysis is unlikely to resolve the controversy of transplant versus chemotherapy for AML in first remission.