ALLOGENEIC VS AUTOLOGOUS STEM-CELL TRANSPLANTATION VS CHEMOTHERAPY INPATIENTS WITH ACUTE MYELOID-LEUKEMIA IN FIRST REMISSION - THE BGMT-87STUDY

In 204 adult patients with de novo acute myeloid leukemia (AML), we pr ospectively compared allogeneic bone marrow transplantation (alloBMT), autologous stem cell transplantation (ASCT) and chemotherapy (Chemo). 162 patients (79.4%) achieved a complete remission (CR). Of the 135 p atients who were still in CR after consolidation, 96 patients were les s than 46 years of age: 36 patients had an HLA-identical sibling donor and were allocated for alloBMT (group I); they were compared to the 6 0 other patients who did not have an HLA-identical sibling donor and w ere treated with either ASCT or chemotherapy (group II). The 3-year di sease-free survival was higher for group I patients (66.5 +/- 16%) tha n for the 60 group II patients (42.4 +/- 13%) (P < 0.05). The actuaria l risk of relapse at 3 years was significantly lower for group I patie nts (24 +/- 15%) than for the other 60 group II patients (56 +/- 13%; P < 0.009). By multivariate analysis, the disease-free survival and ri sk of relapse were influenced by the initial WBC count (P < 0.02 and P < 0.006), the number of chemotherapy courses for CR (P < 0.001 and P < 0.01) and the type of post-induction treatment (alloBMT vs no alloBM T; P < 0.1 and P < 0.02). The 99 patients who did not fulfill the incl usion criteria for alloBMT were given intensive chemotherapy including high-dose aracytine. When they were still in CR (n = 77), these patie nts were then randomized for either ASCT (n = 39) or Chemo (n = 38). W e were unable to detect any statistical difference between ASCT and Ch emo for either disease-free survival, risk of relapse or survival. The se results indicate that alloBMT seems to produce results which are at least superior to those of other therapeutic modalities. The results of either ASCT or Chemo look similar.