HLA-IDENTICAL SIBLING BONE-MARROW TRANSPLANTS VS CHEMOTHERAPY FOR ACUTE MYELOGENOUS LEUKEMIA IN FIRST REMISSION

There is controversy whether adults with acute myelogenous leukemia (A ML) in first remission are best treated with chemotherapy or an HLA-id entical sibling bone marrow transplant. We studied 1097 adults, 16-50 years old, with AML in first remission. Results of transplants from HL A-identical siblings reported to the International Bone Marrow Transpl ant Registry (IBMTR; n=901) were compared with results of chemotherapy in comparable persons treated by the German AML Cooperative Group (GA MLCG; n=196). Preliminary analyses identified subject- and disease-rel ated variables differing between the cohorts and associated with treat ment outcome within each cohort. We adjusted for these variables and d ifferences in time-to-treatment in subsequent comparisons of treatment -related mortality, relapse, survival and leukemia-free survival (LFS) . Five-year probability of treatment-related mortality was greater for transplants than chemotherapy (43% (95% confidence interval, 37-49%) vs 7% (3-11%); P < 0.0001). Five-year relapse probability was less for transplants than chemotherapy (24% (20-28%) vs 63% (55-71%); P < 0.00 01). Five-year probability of survival was similar with transplants an d chemotherapy (48% (43-53%) vs 42% (33-51%); P=0.24). Five-year LFS p robability was higher for transplants than chemotherapy (46% (42-50%) vs 35% (28-41%); P=0.01). These data indicate that bone marrow transpl ants from HLA-identical siblings result in comparable survival but gre ater LFS than chemotherapy in adults with AML in first remission.